April 15, 2018

AFRH Update 12 ► Average 55% Fee Increase OCT 2018

Many residents at the Armed Forces Retirement Home (AFRH) ― particularly those with higher incomes ― will begin paying higher monthly fees in October as officials look to cover more of their operating costs, shore up AFRH finances and decrease the need for taxpayer dollar bailouts. More than three-fourths of the residents live in independent living units, where the average monthly fees paid will increase by about 55 percent ― from $1,226 to $1,895. The cost of providing that independent living unit and associated services such as three meals a day, health care services, transportation and activities is $3,054. “This is a difficult thing to do and not an action we take lightly,” said retired Army Maj. Gen. Stephen Rippe, chief executive officer of the Armed Forces Retirement Home. “Each resident served our nation in uniform, and their experience in the military and the circumstances they live with today as a result of that service are deeply personal.”

The AFRH has 858 residents on two campuses ― one in Washington, D.C., and one in Gulfport, Mississippi. It can accommodate 1,056 residents. The fee increase comes as the result of an analysis of the cost for each level of care at the facility, and an analysis of residents’ income. “We realized when we determined what our cost was, that our maximum fee was dramatically less than that. We had residents who could afford to pay full cost in independent living but the taxpayer was heavily subsidizing it,” said Rippe, who took over as CEO of AFRH in November. He and his staff have been analyzing operations and looking at new ways to bring in more revenue. AFRH and DoD officials have been examining every aspect of the AFRH operations, in the wake of a serious cash flow problem that resulted in nearly depleting the AFRH trust fund. It declined from $186 million in 2010 to $46 million in 2015. AFRH has been operating at a deficit of about $20 million a year, with the shortfall being made up by taxpayers.

Independent living fees are now capped at $1,458 a month or 40 percent of income, whichever is less. New fees will be capped at the actual operating cost of $3,054 or 60 percent of income, whichever is less. While 10 percent of residents will be paying the maximum amount, others will see increases because the calculation will require a higher percentage of income. For those paying less than the operating costs, the difference is subsidized by the 50-cent-a-month deduction from active-duty enlisted service members’ paychecks and fines imposed on enlisted members for disciplinary violations.

Rippe held a town hall with residents 9 APR at the Washington, D.C., campus, and video conferenced with the Gulfport residents. “The reaction when we talked to residents was positive,” he said. The majority of residents have income in the $40,000-a-year range, he said, and many have done research and know the AFRH cost is less than that of other similar facilities. “There are obviously a few people who are disgruntled, especially the people that are in the higher income range ― $60,000, $70,000, $80,000, $90,000 a year, whose fee actually more than doubles,” he said.

One resident of the Washington campus contacted by Military Times disagreed with that overall assessment. He said the fee increase essentially amounts to a 20 percent pay cut, and that residents are “unhappy and disappointed.” “It’s the main topic of conversation” at the home, he said. “There will probably be a mass exodus soon. I will be one of them. “This is a sad story because it will do little to solve the problems. We’re in this situation because of the gross mismanagement over the past five or six years. ... The real losers are the ones who are too old to leave. They have no options.”

No current residents in the level of care of assisted living, long-term care and memory support will pay the new maximum amount because of their income levels, Rippe said. Average fees in those units will drop by 21 percent, to about $2,120 a month, because while the maximum payment will more than double ($10,626 for memory care, $10,413 for long-term care) the income percentage limits will drop from an 80 percent maximum to 70 percent. According to surveys by John Hancock and Genworth Financial, the monthly fee maximums are similar to costs for a private room in long term care in the Washington area. However, those commercial facilities don’t include many of the services AFRH offers, Rippe said. There is no financial test for AFRH residents; eligibility is based on status generally as retired enlisted members ages 60 and older; and certain other former enlisted members incapable of earning a living. Rippe and his staff have been studying other options for increasing the revenue of the AFRH. [Source: ArmyTimes | Karen Jowers | April 9, 2018 ++]

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Navy Fleet Size Update 12 ► 2016 Need Assessment Down-Play

Just in case there was ever any doubt, the Navy really doesn’t want you to hold them to the 355 ship number it said it needed at the end of 2016. Senior Navy leadership has made a cottage industry of down-playing its December 2016 assessment that attempted to match combatant commander demand with the kind of fleet size it might reasonably expect to build. Since Jim Mattis took over as Defense Secretary in January, equivocation has been the order of the day when it comes to what size fleet the Navy is building towards in the era of President Trump.

And that continued 9 APR at Navy League’s annual maritime bonanza, Sea-Air-Space. In response to a question about priorities, the Navy top requirements officer told the crowd to focus less on the 355-ship number. When it comes to fleet lethality, its what’s on the inside that counts, Vice Adm. William Merz told the crowd. “Capability is where we would really like to put most of our energy,” Merz, the deputy chief of naval operations for warfare systems, said. “That’s where we can return capability and make our fleet more lethal much more quickly than just building capacity. There is the capacity piece, the 355-ship Navy, that I’m sure you’re very familiar with. “We caution everybody that 355 is a target,” he continued. “It’s much more important to focus on the sum of the parts to derive from it.” He said that fitting the right capabilities to operational plans and need areas was more important than actually hitting the target number of ships.

Merz is the latest in a long line of 355-ship soft-pedlars, a trend that has continued despite Congress making achieving a 355-ship Navy a matter of national policy as part of the 2018 National Defense Authorization Act. Merz told House lawmakers in March that the Navy was gearing up for a new force structure assessment that would inevitably revise the 355-ship number. When Mattis was pressed last June about growing the fleet to 355 ships, he said the nation needed a larger fleet but that it was unlikely without three-to-five percent real growth in the defense budget annually. Mattis has made clear that restoring readiness in the force is his number one priority.

Navy Secretary Richard Spencer said in September that the Navy needs to grow, but that the service needed to take a hard look at what capabilities the fleet would need in 15 years. The Navy’s own 30-year shipbuilding plan released in February didn’t get to 355 ships at all, capping out at 342 ships in 2039. The Navy’s public squirreliness on its own assessment of its needs have started to irk even its staunchest supporters on Capitol Hill. In a hearing in March, Rep. Rob Wittman, chairman of the House Armed Services Committee’s Seapower subcommittee, said the Navy was missing the mark on its shipbuilding plans. “Critical shortfalls in aircraft carriers, large-deck [amphibious ships] and attack submarines are debilitating to our national security and only serve to embolden potential adversaries,” Wittman said. “The Navy sometimes misses the strategic imperative and national urgency associated with the message our nation needs to sends to the world when an inadequate shipbuilding budget is proposed.”

What this all boils down to is that 355-ships is not a priority for the current administration, said Bryan McGrath, a retired destroyer skipper and consultant with The FerryBridge Group. “I continue to believe that a lot of people (myself included) suffered from irrational exuberance when the president’s 350 campaign promise morphed into a 355 ship force structure assessment in late 2016. When people downplay numbers, it is almost always a way to reconcile tight resources. The bottom line is that if 355 were a Secretary Mattis priority, we’d know it. It isn’t, and so it is likely we will continue to see Navy downplay the number. [Source: NavyTimes | David B. Larter | April 9, 2018 ++]

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Arlington National Cemetery Update 74 ► 2nd Future of the Cemetery Survey

Only 1 percent of all veterans are buried or inurned at Arlington National Cemetery, but the cemetery is still projected to run out of space in two decades unless new land is obtained, eligibility requirements change, or some combination of both. That’s why Congress asked the Department of the Army to consider what could be done to preserve Arlington as an active military cemetery well into the future, and that’s why Arlington has launched a second survey to hear from its stakeholders. The first survey was conducted in July 2017 in partnership with the VFW and other organizations. Those results can be found here. The new survey further refines the first. Finding new land that is adjacent to the cemetery would be extremely difficult in an urban environment, but would closing Joint Base Myer-Henderson Hall be a solution or just prolong the inevitable, since one acre extends the service life of the cemetery by only three months? Should Arlington be reserved just for active-duty deaths, combat deaths, former POWs, high heroism medal recipients, or not? “Your opinion matters — not only to us, but to our military and civilian leaders as they face a difficult future for our hallowed national shrine," said Executive Director of Army National Military Cemeteries Karen Durham-Aguilera. Take the new survey here. [Source: VFW Action Corps Weekly | April 6, 2018 ++]

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TRICARE Problems Investigated Update 02 ► MOAA Town Hall Disclosures

The Military Health System and the TRICARE program are undergoing the most extensive and complex changes in decades. Most of these changes were swept in through the FY 2017 National Defense Authorization Act and have affected almost every facet of the military's health care delivery system. With changes of this magnitude, it's not surprising there has been confusion for military beneficiaries.

The Military Officers Association of America (MOAA) sees and hears from the beneficiary community the angst and frustration resulting from many of these changes. Their recent Facebook Live Town Hall captured the groundswell of dissatisfaction, as theyaddressed these issues with the director of the TRICARE Health Program. Click here to view the whole 40 minute interview . Many of the structural changes to the TRICARE program have been compounded with the change in TRICARE's purchased care contractors in the West and East regions. Despite extensive preparation by both Humana and Health Net, they experienced big challenges early on and have reported to MOAA they are working hard to make adjustments. But they will have to prove it to beneficiaries, many of whom have been surprised to see their TRICARE copayments have increased.

MOAA and others in the beneficiary community are applying pressure on the Defense Health Agency (DHA) to produce improvements and quickly. In a briefing with TRICARE officials, accompanied by Health Net and Humana, they acknowledged key issues most affecting beneficiary experience and issues that require rapid improvement. MOAA has been targeting the following areas Humana and Health Net currently are addressing. They include:

Customer service: Initial call volumes quickly exceeded call center capacities. Additionally, training of new center associates required to learn about the program and its changes have slowed calls.

Referrals and authorizations: These have accumulated an immediate backlog, which required a waiver by the DHA to extend into April (West Region).

Adequate provider networks: This continues to be a problem mainly in areas outside of major military installations and with the new TRICARE Select option.

Claims processing: There have been delays in payments to providers, resulting in some beneficiaries covering the costs. Additionally, accuracy of beneficiary claims statements have been an issue.

Technology and data support: Issues have occurred across a variety of claims, enrollment platforms, and functions, resulting in decreased performance capabilities and accuracy.

Enrollment: Beneficiaries are highly encouraged to update their electronic transfer payments, for example, by credit card to ensure their TRICARE Prime enrollment is up-to-date. It is recommended beneficiaries review recent statements to verify their enrollment transaction went through.

These disruptions do not in any way serve to enhance the beneficiaries' experience with their TRICARE health benefit. MOAA continues to work closely with TRICARE program officials, and with those at Health Net and Humana, to identify and rectify these and many other issues that are brought to their attention by its membership. [Source MOAA Newsletter | Kathryn M. Beasley | April 5, 2018 ++]

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TRICARE Premium ► 45,000 Missing Payment Info to Lose coverage

Troops and family members who missed monthly Tricare premium payments due to a contractor swap 11 JAN must make up missed payments, as well as pay one to two months in advance to reinstate coverage, Tricare officials confirmed 9 APR. When Tricare shifted regions and contractors 1 JAN, premium payment information was reset for thousands of beneficiaries in the West region and former North region. Those users were sent letters by mail in November notifying them to update their payment information or risk losing coverage entirely after 1 JAN. Tricare Young Adult, Reserve Select and Retired Reserve users pay monthly premiums for coverage, while retired

Prime users can make annual or monthly payments. Active-duty families, seniors on Tricare for Life and retirees using Tricare Select do not pay monthly premium fees.

As of late last month, 45,000 Tricare beneficiaries or households were missing payment information. To fix the issue, those users could be required to pay up to thousands of dollars out of pocket at once, depending on their plan, officials said.

Tricare Retired Reserve and Tricare Young Adult users must pay five months out of pocket to keep their plans -- three months retroactively to Jan. 1 and two months in advance, officials said. For beneficiaries using the Tricare Retired Reserve family plan who reinstate coverage immediately, that means almost $5,192 out of pocket -- $1038.31 each for the three missed months, as well as April and May premiums in advance. For a Tricare Young Adult Prime user who fixes the payment issue immediately, that means $1,620 for retroactive and continued coverage.

Tricare Reserve Select and retired Tricare Prime users who do not pay by paycheck allotment must pay for the three missed months and one month in advance, according to Tricare's website.

Tricare officials said all beneficiaries using those plans should check to make sure their payment information is up to date, including those who updated it by late December as instructed in the November notices. That's because a separate Tricare system freeze over December caused an unknown number of updates made before the due date to be lost, officials said last month. Tricare officials warned that users who do not fix the payment problem within 150 days of the last payment, which likely was made 1 DEC, must wait a full year before they can re-enroll. [Source: Military.com | Amy Bushatz | April 9, 2018 ++]

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Military Enlistment Update 19 ► Dependent's Military Health Record Impact | Navy

On the heels of a Military Times story about Army Maj. Rudy De La Rosa's two daughters who were denied entry into the Air Force and Army based on notations in their dependent medical records, four readers told Military Times that their sons had been kicked out of Navy recruit training for similar reasons. While the Air Force and Army merge dependent medical records with service medical records, the Navy doesn’t do the same for new sailors and Marines who follow their parents into military service. However, Navy medical providers still can access those records, a spokeswoman has since clarified, which could result in service members being shown the door based on diagnoses or evaluations never shared with the dependent or their parents.

One mother emailed Military Times to say her son, who would have been the fourth generation in his family to serve in the Navy, was removed from recruit training at Naval Station Great Lakes, Illinois, for a condition “when he was 2 years old and 4 years old, when he was struggling with his dad being deployed.” Another mother said her son was forced out of recruit training one week after he entered on Dec. 13, 2016, at age 20, because of counseling he received when he was 11 or 12. “His father and I were divorcing and thought it was in the best interest of our three children to go through counseling,” she said in an interview. “It was situational ... there were no medications

ordered, nothing.” She said it was clear the medical provider had access to the records because he was citing counseling on several specific dates.

The Air Force and Army began merging prior dependent medical records with service member records in 2004. The Navy initially told Military Times that it doesn’t merge records. After Military Times asked about comments from parents whose children were forced out of recruit training, officials then clarified that its medical staffers still could have access to the dependent records in the electronic system. This sets military dependents apart from their civilian counterparts, who don’t come into the military with a previous electronic health record. “We determined that a provider at a recruit training command would only access a dependent’s [electronic health record] under certain circumstances,” said spokeswoman Mariah Felipe, such as red flags raised as part of a person’s application, if the individual was injured during boot camp or if someone was applying to a rate that required meeting specific physical requirements.

However, the Navy mother interviewed by Military Times said her son “was going through the routine medical exam at recruit training when they noticed he had a dependent medical record,” she said. “He was not in a specialized rating requiring medical clearance, nor did he have an injury.” She also saw a note in her son’s medical record from his counselor that stated at the time he “was stable, and had good coping skills” after four or five counseling sessions in a six-month period, and that no further counseling was warranted, unless the family chose to seek it later. “The Navy pushes so much, especially on the medical side, that if you have any problems whatsoever, to seek help. So when all this came up, I said, ‘Are you kidding me?’ “If I had known it would affect my child like this, I never would have put him in counseling” through the military, she said.

Army Maj. Rudy De La Rosa and his wife Mia felt the same way; they thought they were providing emotional support for their daughters when they took them to counseling to help them cope with multiple moves and his multiple deployments to Afghanistan. Until their oldest daughter was forced out of Air Force basic training and accused initially of fraudulent enlistment, they had no idea there were notations in both daughters’ counseling files that could bar them from joining the military. They contend the notations overstated events that were either extremely mild, or never happened. Despite multiple clean bills of health from civilian and DoD behavioral health providers, their daughters have been denied waivers to enter the military. [Source: NavyTimes | Karen Jowers | April 5, 2018 ++]

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VA Rehabilitation & Prosthetic Services ► Direct Appointment Scheduling Now Possible

With a commitment to ensure Veterans receive quicker access to specialty rehabilitation services and equipment, the U.S. Department of Veterans Affairs (VA) recently implemented a rapid response team to expand staffing and training, increase communication directly with Veterans and improve processes to reduce and eliminate the backlog of pending requests for prosthetic items and services. To improve Veterans’ access to specialty rehabilitation services, enrolled patients at VA medical centers can now schedule appointments directly with amputation care and wheelchair clinics, without having to first see a primary care provider.

This means Veterans will not have to make an extra appointment and travel to a VA facility for a referral. Direct scheduling is currently available at 137 VA facilities for amputation care and at 124 VA facilities for wheelchair clinics. Additionally, same-day access for orthotist/prosthetist clinical services is available at 141 VA facilities. “The dedication and support of the multidisciplinary team of VA employees who are implementing these improvements demonstrate their commitment to do the right thing for our Veterans,” said Robert Wilkie, Acting Secretary of Veterans Affairs. “We are focused on implementing the best solutions to modernize how we deliver rehabilitation and prosthetic services across all VA medical centers — ensuring Veterans nationwide are receiving timely and integrated health care and support.”

As the largest and most comprehensive provider of prosthetic devices and sensory aids in the country, VA Prosthetics and Sensory Aids Service currently averages 638,000 new requests monthly across its health-care system for such items. The service provides a full range of equipment and services to Veterans, including artificial limbs and bracing, wheeled mobility and seating systems, sensory-neural aids (e.g., hearing aids, eyeglasses), implants and devices surgically placed in the Veteran (e.g., hips and pacemakers), and home respiratory care. VA is working to ensure Veterans are receiving their medical items, equipment and supplies sooner. Since June 2017, the total number of requests for prosthetic items pending for more than 30 days has been reduced by 72 percent. [Source: VA News Release | April 4, 2018 ++]

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VA Presumptive Disabilities ► Top 10 Claimed and Agent Orange

Click on highlighted condition for description and symptoms:

Top 10: Those That SERVED | Post Traumatic Stress Disorder, Sleep Apnea, Diabetes Type II, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, Tinnitus, Peripheral Neuropathy, Depression, Anxiety, and Various Skin Disorders

Agent Orange Related

1.  Acute & Subacute Peripheral Neuropathy2.  Adult Fibrosarcoma3.  Alveolar Soft Part Sarcoma4.  Angiosarcoma5.  B-Cell Leukemias6.  Bone Pain7.  Chloracne8.  Clear Cell Sarcoma of Aponeuroses9.  Clear Cell Sarcoma of Tendons & Aponeuroses10.  Congenital Fibrosarcoma11.  Dermatofibrosarcoma Protuberans12.  Ectomesenchymoma13.  Epithelioid Malignant Leiomyosarcoma14.  Epithelioid & Grandular Mailignant Schwannomas

15.  Epitheliod Sarcoma16.  Extraskeletal Ewing's Sarcoma17.  Hemangiosarcoma18.  Hodgklin's Disease19.  Infantile Fibrosarcoma20.  Ischemic Heart Disease (IHD)21.  Leiomyosarcoma22.  Liposarcoma23.  Lymphangiosarcoma24.  Malignant Fibrous Histiocytoma25.  Malignant Ganglioneuroma26.  Malignant Giant Cell Tumor of the Tendon Sheath27.  Malignant Glandular Schwannoma28.  Malignant Granular Cell Tumor29.  Malignant Hemangiopericytoma30.  Malignant Leiomyoblastoma31.  Malignant Mesenchymoma32.  Malignant Schwannoma with Rhabdomyoblastic Differentiation33.  Malignant Synovioma34.  Multiple Myeloma35.  Non-Hodgkin's Lymphoma36.  Parkinson's Disease37.  Porphyria Cutanea Tarda38.  Proliferating Angiendothliomatosis39.  Prostate Cancer40.  Respiratory Cancer41.  Rhabdomyosarcoma42.  Synovial Sarcoma43.  Type II Diabetes

[Source: http://www.veteranprograms.com/pd-full-list.html | April 2018 ++]

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VA Vacancies ► Wait Time & Outsourcing Impact

The Department of Veterans Affairs, facing intense scrutiny amid reports of widespread dysfunction and a controversial push by the Trump administration to outsource more medical care, has tens of thousands of full- and part-time vacancies nationwide, according to data compiled by veterans advocates, lawmakers and federal unions. Most urgently, the agency's health-care network needs thousands of primary care physicians, mental-health providers, physical therapists, social workers - even janitorial staff, Sen. Jon Tester (D-MT), ranking member of the Senate Veterans' Affairs Committee, told The Washington Post in an interview. Of equal concern, he said, VA lacks enough human-resources personnel to vet candidates and make the hires. "It's crippling our ability to deliver health care to our vets," Tester said. " . . . It's effectively pushing veterans outside the system."

President Donald Trump, and the conservative groups advising him, has seized on the long waits many veterans face at government facilities as grounds for aggressively expanding a program that enables patients to seek services from private providers at taxpayer expense. The proposal is deeply divisive, however, with opponents, including Democrats and Republicans in Congress, saying the effort could further weaken VA. Max Stier, president and chief executive officer of the nonprofit Partnership for Public Service, said that when Trump took office, he put into place a federal hiring freeze that has been a particular problem for VA as it looks to add staff. While doctors were exempt from the hiring freeze, the human resources professionals needed to make the hires were not, he noted, citing a 2017 report by the Government Accountability Office. VA's human resources division remains short-staffed and continues to struggle with hiring even after the freeze was lifted, Stier said.

VA officials said the vacancy rate in human resources is 11.5 percent, or 540 employees. That has not affected "our numerous staffing successes," said Curt Cashour, a VA spokesman, who noted that the department has added nearly 15,000 staff since Trump came into office. Across the agency, there were more than 33,000 full-time vacancies as of early March, Cashour said. He would not provide the number of part-time vacancies, a figure also believed to be in the thousands. "Historically, one of the main benefits of working at the VA is stability. Unfortunately, people working in the health-care field are increasingly not viewing the VA as stable, and it is making recruitment more difficult because of that," said Randy Erwin, president of the National Federation of Federal Employees. "It is a real problem."

A Senate hearing was scheduled for 11 APR to confirm Paul Lawrence to become VA's undersecretary for benefits, a key post that has gone without a permanent leader since October 2015. Lawrence is a retired Army officer and vice president of the consulting firm Kaiser Associates; his nomination is considered noncontroversial. The role of undersecretary for health also remains vacant. Cashour said the VA is "making steady progress" in its search for a permanent appointee. "VA has made phenomenal progress during the Trump administration when it comes to VA staffing," Cashour said. More than one-third of veterans enrolled in the VA system - which serves 9 million veterans a year at 1,200 hospitals and clinics - now receive care from private doctors.

At a hearing before he was fired, Shulkin spoke about the difficulty in hiring doctors and nurses, mental health care professionals and benefits claims officers. The agency offers lower pay than the private sector does and involves a tedious, government mandated recruiting process. It is not clear what is nominee Jackson's philosophy regarding outsourcing care. But health-care experts and veterans advocates say the private system is also overwhelmed by long wait times. The solution is not outsourcing more care, said Rick Weidman, executive director of policy and government affairs for Vietnam Veterans of America. "You can't just toss millions of veterans into the private health-care system, which wasn't built to care for their specific needs as vets," he said. "The VA needs full staffing. It's irresponsible and not fair." [Source: Emily Wax-Thibodeaux | The Washington Post | April 10, 2018 ++]

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VA Vet Choice Update 74 ► TriWest Healthcare Alliance Warning Letter to Congress

TriWest Healthcare Alliance, which contracts with the Department of Veterans Affairs to arrange private-sector care for veterans through the VA Choice program, warned 3 APR in an apocalyptic letter to lawmakers that another

funding shortfall could lead to restricted care for veterans, as well as layoffs and financial ruin for the alliance. In a letter sent to leaders on the House and Senate VA committees and congressional appropriators, TriWest President and CEO David McIntyre Jr. criticized Congress for failing to address the shortfall in the massive spending bill passed 23 MAR. The funding uncertainty threatens TriWest’s network of private-sector medical providers, he wrote. “I cannot predict how much longer this company’s owners and employees are going to be willing or able to stay at this work,” McIntyre wrote.

Former VA Secretary David Shulkin warned lawmakers during his last few appearances on Capitol Hill that funds for the Choice program would be depleted by early June. The program allows veterans to receive care in the private sector if they live more than 40 miles driving distance from a VA facility or have to wait more than 30 days for an appointment. If Congress doesn’t approve more funding soon, Shulkin has said, the VA must further limit the number of veterans who could use private-sector medical care.

TriWest, based in Phoenix, is one of the third-party administrators that run the program. The company works with the VA and approximately 200,000 private-sector medical providers to schedule appointments for veterans in 28 states in the Midwest and along the West Coast. It also operates in Guam, American Samoa and the Northern Mariana Islands. As the June deadline approaches, TriWest faces a “very real financial threat,” McIntyre wrote. The company is preparing to lay off up to 25 percent of its workforce, which accounts for 700 people. “Veterans will be denied access to the community provider network we have constructed to support VA, providers likely will experience substantial claims payment delays, and TriWest will be forced to reduce as much as 25 percent of our workforce just to survive, if that’s even possible,” McIntyre wrote.

This marks the third instance in one year that the Choice program has faced a funding crisis. The last time, in December 2017, Congress approved $2.1 billion to keep the program going. As of mid-March, about $1 billion remained, and the VA was spending about $370 million through the program each month. [Source: Nikki Wentling | Stars & Stripes | April 3, 2018 ++]

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VA Vet Choice Update 75 ► Congress Again Urged to Pass VA Reform Package.

The acting secretary of the Department of Veterans Affairs supports a package of VA reforms Congress failed to pass last month and urged lawmakers 9 APR to try again. Robert Wilkie wrote in a statement that the VA and Congress need to come together to overhaul the VA Choice program, which veterans use to receive private-sector medical care. Lawmakers and large veterans organizations agree the program is complex and difficult for veterans to use, and they’ve been working for more than a year to garner support to pass large-scale reforms. The Choice program was created in response to the VA wait-time scandal – uncovered in Phoenix four years ago Monday. “It’s time to fix the Choice program – as well as the department’s other non-VA care efforts – once and for all by merging them into a single, streamlined community care program that’s easy to use for veterans and VA employees,” Wilkie wrote.

Wilkie told members of the House and Senate veterans’ affairs committees that he supported a package of reforms they failed to attach to Congress’ massive spending bill in March. The package was a deal between Rep. Phil Roe (R-TN), the chairman of the House Committee on Veterans’ Affairs, and Sens. Johnny Isakson (R-GA) and Jon Tester (D-MT) who lead the Senate Veterans’ Affairs Committee. In addition to overhauling the Choice program, the reforms included an expansion of benefits for veteran caregivers, as well as a plan to initiate a

systematic review of VA infrastructure, with the intention of disposing of aging and underused facilities nationwide.

Wilkie expressed urgency, noting Congress has been forced in multiple instances during the last year to approve emergency funding for the program. The program faces another funding shortfall – it’s slated to run out of money in early June. TriWest Healthcare Alliance, which contracts with the VA to arrange private-sector care for veterans through the Choice program, warned lawmakers last week that another shortfall could lead to restricted care for veterans, as well as layoffs and financial ruin for the alliance. Wilkie, who came to the VA from the Defense Department, is temporarily leading the VA following the dismissal of former VA Secretary David Shulkin on 28 MAR. He sat down with several large veterans organizations for the first time 6 APR and is scheduled to meet with Roe in the coming days.

In an official release last week, the VA rejected claims by Shulkin that he was fired because administration officials sought to privatize the agency and saw him as an obstacle. “There is no effort underway to privatize VA, and to suggest otherwise is completely false and a red herring designed to distract and avoid honest debate about the real issues surrounding veterans’ health care,” the VA statement read. It’s uncertain whether Congress can gain enough support for major VA reforms before veterans and lawmakers hear from Rear Adm. Ronny Jackson, the White House physician and President Donald Trump’s pick to lead the VA. Some lawmakers and veterans groups have expressed concern over Jackson’s lack of management experience and knowledge of VA issues. They were looking to Jackson’s confirmation hearing to learn more about him and the direction that he wants to lead the massive agency. A confirmation hearing for Jackson had not yet been scheduled.

Roe said Monday that he was working with other lawmakers to “find a path forward” for the reforms. “I am grateful acting Secretary Wilkie expressed his support of the bicameral, bipartisan agreement reached in March, and that he is bringing increased awareness to the limited funding remaining in the Choice Program account,” Roe said. [Source: | Stars & Stripes | Nikki Wentling | April 9, 2018 ++]

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VA National Transplant Program ► Where To Go

Solid organ (kidney, liver, heart, lung, kidney/pancreas, heart/lung,) and bone marrow/stem cell are important, life-saving procedures. The Veterans Health Administration has offered solid organ transplant services since 1962 and bone marrow transplant services since 1982. VA Transplant Centers are located across the country. For a list of the 12 VA medical facilities which provide transplant services and the type of transplant they service go to https://www.va.gov/health/services/transplant. For more information regarding the VA National Transplant Program, contact your VA specialist, primary care provider, or nearest VA medical facility. For a list of VA medical facilities view the VA directory at https://www.va.gov/directory/guide/division.asp?dnum=1. [Source: https://www.va.gov/health/services/transplant | April 2018 ++]

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VA Claim Notice of Disagreement ► When to File

Use the Notice of Disagreement (NOD) form 21-0958 to indicate to your Regional Office (RO) that you disagree with a decision you received regarding your claim for disability compensation. Examples of these decisions may include entitlement to service connection, percentage of evaluation assigned, and effective date among other things. Only fill out this from if you disagree with a decision issued by your RO. This includes an initial decision, a decision for an increased rating, or any other decision you disagree with. You can ask the Department of Veterans Affairs (VA) to help you fill out the form by contacting your local VA. Before you contact the VA, please make sure you gather the necessary information and materials, and complete as much of the form as you can.

Upon completing the NOD you should provide your signature in the block provided at the bottom of the second page. Be sure to sign every form you fill out before you send it to us. If you don't sign the form, VA will return it for you to sign, and it will take a longer process. Attach any materials that support and explain your NOD. Mail or take your NOD to the RO that issued the decision or notification that you disagree with, which is the Agency of Original Jurisdiction (AOJ.) It is important that you keep a copy of all completed forms and materials you give to VA. You can download the form at https://www.vba.va.gov/pubs/forms/VBA-21-0958-ARE.pdf. [Source: U.S. Veteran Compensation Programs | April 9, 2018 ++]

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VA Disability Benefits Update 01 ► 19-Year-Old Pain Precedent Overturned

Thousands of veterans previously denied disability benefits for pain issues related to their military service may now be eligible for that assistance, thanks to a federal court ruling this week. On 4 APR, the U.S. Court of Appeals for the Federal Circuit overturned a 19-year-old precedent used in more than 11,000 VA claims denials that stated veterans had to have a clear medical diagnosis connected to their pain in order to be eligible for those disability payouts. Advocates said the ruling could be life-changing for individuals who are unable to work because of service-connected injuries but excluded from veterans assistance because of medical technicalities.

“This was an all-or-nothing issue,” said Bart Stichman, executive director and co-founder of the National Veterans Legal Services Program (NVLSP). “This isn’t about arguing over the degree of disability where it is the difference of $2,000 or $3,000 a month in help. These are people who are getting zero benefits, despite their pain.” The court challenge, which was brought by NVLSP, involved Army veteran Melba Saunders, who served in first Gulf War. She injured her knees during her seven years in service, a fact that military doctors noted in her files without determining a specific medical diagnosis of the issue. When she left the service and applied for veterans disability benefits, her claim was denied. VA officials acknowledged the problem stemmed from her time in service but the Board of Veterans’ Appeals cited a 1999 Veterans Court decision which held that “pain alone is not a disability for the purpose of VA disability compensation.”

The new court ruling erases that precedent, at least for now. Veterans still need to show a clear connection between their pain and their military service to be eligible, but would not longer have to have a specific medical

reason for the pain to apply for benefits. VA officials can appeal the decision, although it’s unclear if they will do so. In a statement, Saunders’ lawyer, Mel Bostwick, called the court case “a significant victory for disabled veterans” and a long-overdue correction in VA policy. “Congress recognized that the nation owes these veterans for their sacrifices, and the court today vindicated the common-sense notion that this debt does not depend on whether a veteran’s disabling pain can be labeled with a specific medical diagnosis,” she said.

Stichman said veterans who have previously been rejected for disability benefits — or who have avoided applying in the past because they assumed they would not be eligible — should now reapply to see if the new ruling will allow them to qualify. “We just don’t know how many veterans this could affect,” he said. “We know the Board of Veterans Appeals has cited this precedent in more than 11,000 cases. But we don’t know about all the other veterans who never even applied.” [Source: MarineCorpsTimes | Leo Shane III | April 5, 2018 ++]

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CRSC Update 26 ► Are You Missing Out?

Just because a veteran was not injured in combat does not mean he or she may not be entitled to receive Combat-Related Special Compensation (CRSC). Many veterans may be missing out on hundreds, if not thousands, of dollars every month because they have not applied for the special compensation. Don’t let the term combat throw you; there are many circumstances which are combat related that could justify approval of extra tax-free money for you.

CRSC is designed to restore military retirement pay that has been offset by Department of Veterans Affairs (VA) compensation when evidence exists to confirm the associated disabilities are combat related. For example, if a veteran is currently rated for disability of 10 percent with the VA, he or she receives a check from the VA for $115 each month, but his or her retired pay is reduced by the same amount. If the disability is found to be combat-related by the CRSC review board, he or she would continue to receive the monthly check from the VA for $115 along with the remainder of the retired pay, but begin to receive an additional monthly check from the CRSC for $115.

Many disabilities that resulted from conditions during peacetime may meet the criteria for CRSC. Some examples are an aircraft mechanic who works on the flight line and begins to lose his hearing while in-service; a personnel technician who dives for cover during a simulated air raid and injures her shoulder; and a special forces journeyman who makes a peacetime parachute jump and breaks his ankle upon landing. If you’re not sure the circumstances surrounding your disability meet the combat-related criteria, it would be beneficial for you to apply for CRSC and let the board make a determination for you. There are a few prerequisites to consider before submitting a CRSC application. To meet the basic eligibility criteria to be considered for CRSC, veterans must:

Be retired with 20 (or more) years of active-duty military service, or retired at age 60 from the Guard or Reserve and

Be receiving military retired pay and

Have a compensable VA disability rating of 10 percent or higher and Receive military retired pay that is reduced by VA disability payments.

NOTE: Veterans who waived military retirement pay for Civil Service credit are not eligible to apply for CRSC. The application for Combat-Related Special Compensation can be obtained by going to http://www.naus.org/wp-content/uploads/2015/07/DD2860.pdf. [Source: USVCP | February 23, 2018 ++]

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VA Privatization Update 13 ► Debunking The Myth

There is no effort underway to privatize VA, and to suggest otherwise is completely false and a red herring designed to distract and avoid honest debate on the real issues surrounding Veterans’ health care.   Facts Debunk the Privatization Myth: A Two-Decade Comparison

In 1998, VA’s budget was $42.38 billion.VA’s 2018 enacted budget is more than four times that figure at $188.65 billion.

In 1998, VA had 240,846 employees. As of March 29, 2018, VA had 385,233 employees, a nearly 60 percent increase in 20 years.

VA has increased its end strength by nearly 15,000 since the beginning of the Trump administration, from roughly 370,000 to 385,233 as of March 29, 2018.

In 2000 VA had 1,110 medical facilities. Today, VA has 130 more medical facilities, for a total of 1,240.  VA Community Care Has Existed for More Than 70 Years, and Has Nothing to Do with Privatization

VA has been offering community care since the World War II era, starting with the then-Veterans Administration’s Hometown Program that began in 1945. As former Secretary Shulkin said, "No health care provider delivers every treatment under the sun. Referral programs for patients to get care through outside providers (known as Choice or Community Care at the VA) are as essential to the medical profession as stethoscopes and tongue depressors."

Currently, VA operates seven distinct community care programs. VA is working with Congress to merge all of VA’s community care efforts into a single, streamlined program that’s easy for Veterans and VA employees to use so the department can work with Veterans to coordinate their care with private providers when VA can’t provide the care in a timely way or when it’s in Veterans’ best medical interest. 

The fact is that demand for Veterans’ health care is outpacing VA’s ability to supply it wholly in-house.   And with America facing a looming doctor shortage, VA has to be able to share health care resources with the private sector through an effective community care program. There is just no other option and, once again, VA has offered this solution since the World War II era.

 The Bottom Line on the Privatization Myth "If we’re trying to privatize, we’re not doing a very good job,"..."We’ve gone from 250,000 employees in the VA in 2009 to 370,000 employees, and we’ve gone from a $93.5 billion budget to what the president’s asked this year is $198 billion. It sounds like we’ve been an utter failure if we’re trying to privatize." – House Committee on Veterans’ Affairs Chairman Phil Roe

[Source: VA News Release | April 5, 2018 ++]

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VA Privatization Update 14 ► What Does Privatization Really Mean?

When confirmation hearings for the next Veterans Affairs secretary begin in a few weeks, privatization of the department will be the main focus of most lawmakers’ questions. Nearly everyone in the veterans community and on Capitol Hill is against privatizing VA — and nearly everyone has a different definition of what privatization is. Last week, VA officials released a statement titled “Debunking the VA Privatization Myth,” which insists “there is no effort underway to privatize VA,” and “to suggest otherwise is completely false and a red herring designed to distract and avoid honest debate on the real issues surrounding veterans’ health care.” The move came in response to comments from former VA Secretary David Shulkin, fired by President Donald Trump.

In an op-ed just hours after his dismissal, Shulkin warned of individuals within the White House who “seek to privatize veteran health care as an alternative to government-run VA care.” But the definition of what privatizing the nearly $200 billion department would mean depends largely on who is making the argument. The VA “debunking” statement notes that the department budget has gone up five times in the last 20 years, and the VA workforce has increased about 60 percent since then (to around 385,000 workers). The argument is that adding more resources to the bureaucracy can’t be considered privatizing VA. But veterans groups have noted that increase is a function of inflation and increased demands on the department, and has little to do with future plans to shift more resources into community care programs in lieu of building up more VA infrastructure.

Shulkin warned in his piece against “dismantling of the department’s extensive health care system,” but he also supported closing down a number of aging VA facilities and increasing partnerships with private-sector physicians to improve veterans’ access to medical appointments. Meanwhile, both Democrats and Republicans on Capitol Hill have vowed to oppose “privatization” of VA even as they near an agreement that could substantially increase the number of outside care appointments for veterans, something that multiple lawmakers just a few years ago said amounted to outsourcing VA responsibilities. “The folks who actually want to privatize VA won’t use the word, because they know it’s a political fight,” said Paul Rieckhoff, executive director at Iraq and Afghanistan Veterans of America. “But there’s no doubt it is already happening.”

Moving veterans outside VA

During the 2016 presidential campaign, then-Republican candidate Ben Carson suggested eliminating VA medical programs in favor of health care vouchers that veterans could take anywhere in the country. By nearly any advocate’s definition, that idea amounts to fully privatizing VA. The plan has been floated several times over the years, but it has failed to gain serious traction because of the dramatic effects it would have on existing care programs. About $72 billion of VA’s budget this fiscal year goes to medical care, and the department has more than 1,200 medical facilities nationwide. With Carson’s model as the extreme edge of the debate, the privatization fight largely hinges on how much medical care should go outside the department’s existing infrastructure, and what counts as too much reliance on the private sector.

Last year, VA administrators coordinated more than 60 million medical appointments for veterans. More than one-third of them were with doctors and offices outside the Veterans Health Administration, either because the department didn’t offer the right services or officials felt veterans would be better cared for through outside options. Critics of the administration have warned that increasing the percentage of appointments — and money — heading out of VA and into the private sector could weaken department services. “Each time you’re taking resources out and putting them into the private sector, you’re leaving VA dying on the vine,” said Will Fischer, director of government relations for VoteVets.org. “It’s bit by bit draining of VA.”

For Fischer’s group — which has ties to the Democratic Party and has attacked Trump on a host of national security issues — the department is already on a dangerously close path to privatization, with plans to bump up community care programs to more than $14 billion in fiscal 2019. Rieckhoff said he defines privatization as “any dollar spent by the government on government programs that goes to the private sector instead.” By that definition, large swaths of VA programs have been privatized for years. “The real fight here is over ‘full privatization’ versus ‘expanded privatization’ at VA,” he said. “But you can’t say you want more private care options in the community through VA but you are totally against privatization. That doesn’t make sense.”

Most of the larger veterans groups have used the charges of privatization to express serious concerns about efforts to boost outside care programs, and pushed to match them with equal funding to ensure that VA medical centers are being improved, not ignored. “Our view is that Congress and the administration must fix what is wrong with the VA health care system — improve hiring authorities, expand and fix its aging infrastructure, improve access, customer service — and not just simply turn to the private sector when VA facilities are having problems,” said Carlos Fuentes, director of the National Legislative Service at Veterans of Foreign Wars. “Community care is part of the solution, but not the only answer.”

Privatization vs. Choice

One of the more recent proposals that alarmed some vets groups was a proposal by Rep. Doug (R-CO) that would create a veterans health insurance program to allow participants to skip the department procedures entirely and get private-sector medical care at taxpayers’ expense. When it was introduced last fall, VFW officials blasted the idea as an effort to “kill the VA as a provider of care to America’s veterans” and labeled it a blatant “privatization attempt” by the congressman. He bristled at the accusation. “Our veterans deserve the highest degree of care,” he said in a statement. “Giving them options to choose their healthcare plans and doctors is empowering.” The plan closely tracks with one previously backed by Concerned Veterans for America, which has close ties to the conservative Koch brothers’ network and the Trump administration.

In 2015, the group issued a report calling for converting the Veterans Health Administration into a government-chartered nonprofit and having it compete against private-sector companies for federal funding. Veterans groups have said that amounts to privatizing VA responsibilities. CVA officials say that’s ridiculous. Dan Caldwell, executive director at CVA, said selling off VA facilities or completely defunding the department would equal privatization. But “the misrepresentation of efforts to expand veteran health care choice as ‘privatization’ is simply an attempt to undermine popular and common sense concepts which have overwhelming support among veterans.”

Slowly siphoning resources

Many of the privatization fights surrounding VA trace back to 2014, in the wake of the wait-time scandal that forced the resignation of then-Secretary Eric Shinseki. In an effort to get veterans quicker access to medical appointments, Congress approved (by an overwhelmingly bipartisan majority) a new VA Choice program that allowed veterans who faced long waits for department care or long travels to department hospitals to instead pay for medical treatments in their community with public dollars. The idea drew criticism from some liberal groups, who warned the three-year program would slowly siphon off resources from the federal health system and that money would be better spent hiring more VA physicians and improving existing VA hospitals.

Since then, VA officials under Trump and former President Barack Obama have pushed for more simplification and flexibility on a range of community care programs, including Choice. Lawmakers removed the program’s end date last summer and added $2 billion more to the program’s original $10 billion funding cost. That has intensified the privatization accusations. “Once you start cannibalizing VA infrastructure, you are on your way to privatization,” said Lou Celli, national veterans affairs director for The American Legion. He and other veterans groups worry that critics of the VA system will look at reduced numbers of patients at department hospitals as reasons to slash funding and staff, creating a death spiral for the system. “The word ‘choice’ has become a dog whistle for urging veterans to seek care outside of the VA,” said Sherman Gillums Jr., AMVETS’ chief strategy officer. “The demand for healthcare would then become profitable for corporations and organizations that provide healthcare, essentially commoditizing veterans healthcare, with no competition from a government system.”

Advocates note that outside doctors don’t have expertise in identifying service-connected injuries like burn pit exposure and post-traumatic stress disorder. “Maintaining an effective system of the things VA does best is a must,” said Carl Blake, executive director at Paralyzed Veterans of America. “It’s specialized services like spinal cord injury care, polytrauma, amputee and mental health. Those services don’t exist in a vacuum and are at risk when the system shrinks to support the greater cost in the community.”

The looming VA fights

Trump’s VA has pushed back on the idea that shifting more care outside the VA equals privatization of core department missions, even though the president just two months after the election said he would consider privatizing some parts of the department if it means better care for veterans. Leaders in the House and Senate for months have been working on a VA health care overhaul package that would broaden eligibility for private-sector veterans care even more than the existing Choice program. Veterans who previously didn’t meet travel criteria could appeal based on the quality of services rendered in their community, or even opt for two walk-in appointments with private-sector doctors at taxpayers expense without any prior approval from VA administrators. But the Republican-authored plan, which was nearly passed as part of the budget omnibus package last month, also keeps most aspects of veterans health care under VA control, giving department officials the right to deny outside care in some cases.

Senate Democrats have given support for the measure, even though it likely will mean increasing the number of appointments paid for outside VA. House Democrats have expressed reservations in recent negotiations, with some voicing concerns that it amounts to privatization. White House officials have argued department managers should have as little role as possible, possibly even none at all, in deciding what doctor a veteran can visit. Shulkin

and mainstream veterans groups have argued that VA cannot be completely divorced from patients’ care without dangerous health consequences. Whether the proposal can move through Congress while lawmakers are considering the new VA secretary nominee is unclear. But regardless, that nominee — White House physician Ronny Jackson — is expected to face a slew of questions on those “privatization” issues during his meetings with lawmakers in coming weeks, and during his confirmation hearing.

In a statement, House Veterans’ Affairs Committee ranking member Tim Walz (D-MN) said that he wants to make sure Trump’s new pick to lead VA is ready to “put veterans first, listen to [veterans service organizations], and fight any and all attempts to fully privatize the VA.” Sen. Tammy Duckworth (D-IL) and herself a wounded Iraq War veteran, has already warned that she believes the Trump administration “wants to push VA down the dangerous path of privatization.” Administration officials say that simply isn’t true. “The fact is that demand for veterans’ health care is outpacing VA’s ability to supply it wholly in-house,” VA’s statement said. “And with America facing a looming doctor shortage, VA has to be able to share health care resources with the private sector through an effective community care program. “There is just no other option.” [Source MilitaryTimes | Leo Shane III | April 10, 2018 ++]

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VA Burial Benefits Update 45 ► Hmong and Laotian Vets Now Eligible

Hmong and Laotian veterans who fought alongside the United States during a “secret war” in Laos against North Vietnamese forces celebrated a legislative victory last month after the passage of a bill that allows them to be buried in national cemeteries. On 23 MAR, the Hmong Veterans' Service Recognition Act was enacted as part of the Consolidated Appropriations Act of 2018. The legislation, introduced in Congress by Rep. Jim Costa (D-CA) in December 2017, takes effect more than 40 years after the end of the secret war. It allows some Hmong- and Laotian-American veterans to be buried in U.S. national cemeteries, excluding Arlington National Cemetery, and applies to only veterans who pass away on or after the bill's enactment.

Costa, whose district includes Fresno, California, which is home to more than 20,000 people of Hmong descent, according to the 2010 Census, previously sponsored four similar measures to extend burial benefits to Hmong and Laotian veterans. During the Laotian Civil War, the CIA recruited Hmong and Lao soldiers to fight against communist forces. At the end of the war, those who came to the U.S. as refugees were provided an expedited pathway to citizenship through naturalization. “These brave men and women fought shoulder-to-shoulder with U.S. Armed Forces during the Vietnam War, and they have earned this honor and recognition,” Costa said. “I have been working closely with our local veterans leaders and my House and Senate colleagues on a bipartisan basis to secure these benefits for our SGU veterans for nearly 10 years, and seeing our nation finally extend these benefits is a huge victory for our veterans and their families.”

Between 6,900 and 9,700 veterans would qualify for the burial benefit, according to a 2015 estimate from a veterans group. Costa hosted a press conference on 29 MAR at the Lao Hmong American War Memorial in Fresno County Courthouse Park to announce and celebrate the legislation. Between 40 and 50 people attended the event on according to Claudia Larson, Costa's spokesperson. Among those in attendance was Peter Vang, the son of a

veteran and executive director of Lao Veterans of America — a Laotian- and Hmong-American nonprofit veterans organization. In an email, Vang said he is extremely happy about the bill's passage.

“Lao Veterans of America has been working very hard for many years on this bill,” he said. “I am now can tell my father and many thousand Hmong Veterans who fought with the US. Government (CIA) during the secret war in Laos from 1961-1975 that now they can chose to be burial at the Veterans National Cemetery. Their children will be very proud … This is making history for us.”

[Source: NBC News | Agnes Constante | April 3,.2018 ++]

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VA Secretary Update 71 ► David J. Shulkin's Departing Comments

It has been my greatest professional honor to serve our country’s more than 20 million veterans. Almost three years ago, I left my private sector job running hospitals and came to Washington to repay my gratitude to the men and women who put their lives on the line for our country.

I believe strongly in the mission of the Department of Veterans Affairs, and nothing about my political experience in Washington could ever change that. I also believe that maintaining a strong V.A. is an essential piece of the puzzle that is the United States’ national security system: We can only expect our sons and daughters to risk their lives and fight for our freedom if we can keep our promise to care for them when they return home broken, injured or traumatized. There is no excuse for not holding up our end of the bargain. The mission set forth by President Abraham Lincoln to care for those who have “borne the battle” is a sacred duty that I will remain committed to always.

During my tenure at the department, we have accomplished a tremendous amount. We passed critical legislation that improved the appeals process for veterans seeking disability benefits, enacted a new G.I. Bill and helped ensure that we employ the right people to work at the department. We have expanded access to health care by reducing wait times, increasing productivity and working more closely with the private sector. We have put in place more and better mental health services for those suffering from the invisible wounds of war. We are now processing more disability claims and appeals than ever before and, for the first time, allowing veterans to see the status of their appeals by simply logging on to their accounts. Unemployment among veterans is near its lowest level in years, at 3.5 percent, and the percent of veterans who have regained trust in V.A. services has risen to 70 percent, from 46 percent four years ago.

It seems that these successes within the department have intensified the ambitions of people who want to put V.A. health care in the hands of the private sector. I believe differences in philosophy deserve robust debate, and solutions should be determined based on the merits of the arguments. The advocates within the administration for

privatizing V.A. health services, however, reject this approach. They saw me as an obstacle to privatization who had to be removed. That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.

Until the past few months, veteran issues were dealt with in a largely bipartisan way. (My 100-0 Senate confirmation was perhaps the best evidence that the V.A. has been the exception to Washington’s political polarization). Unfortunately, the department has become entangled in a brutal power struggle, with some political appointees choosing to promote their agendas instead of what’s best for veterans. These individuals, who seek to privatize veteran health care as an alternative to government-run V.A. care, unfortunately fail to engage in realistic plans regarding who will care for the more than 9 million veterans who rely on the department for life-sustaining care.

The private sector, already struggling to provide adequate access to care in many communities, is ill-prepared to handle the number and complexity of patients that would come from closing or downsizing V.A. hospitals and clinics, particularly when it involves the mental health needs of people scarred by the horrors of war. Working with community providers to adequately ensure that veterans’ needs are met is a good practice. But privatization leading to the dismantling of the department’s extensive health care system is a terrible idea. The department’s understanding of service-related health problems, its groundbreaking research and its special ability to work with military veterans cannot be easily replicated in the private sector.

I have fought to stand up for this great department and all that it embodies. In recent months, though, the environment in Washington has turned so toxic, chaotic, disrespectful and subversive that it became impossible for me to accomplish the important work that our veterans need and deserve. I can assure you that I will continue to speak out against those who seek to harm the V.A. by putting their personal agendas in front of the well-being of our veterans.

As many of you know, I am a physician, not a politician. I came to government with an understanding that Washington can be ugly, but I assumed that I could avoid all of the ugliness by staying true to my values. I have been falsely accused of things by people who wanted me out of the way. But despite these politically based attacks on me and my family’s character, I am proud of my record and know that I acted with the utmost integrity. Unfortunately, none of that mattered.

As I prepare to leave government, I am struck by a recurring thought: It should not be this hard to serve your country.

[Source: The New York Times | David J. Shulkin | March 28, 2018 ++]

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VA Secretary Update 72 ► Shulkin Did Not Leave Office Willingly

Former veterans affairs secretary David Shulkin said 1 APR that he did not voluntarily leave his office, clashing with the White House’s description of his exit and adding to questions about who will run the department until a new secretary is confirmed. “I would not resign, because I’m committed to making sure this job was seen through to the very end,” Shulkin said in an interview on CNN’s “State of the Union” with Jake Tapper. “I did not resign.” Shulkin made similar comments on NBC’s “Meet the Press,” saying that he did not submit a letter of resignation, and was not asked to.

Whether Shulkin resigned or was fired would have bearing on who leads the Department of Veterans Affairs until the president’s nominee, Navy Rear Adm. Ronny L. Jackson, is confirmed by the Senate. According to federal statutes, the departure of a Senate-confirmed secretary elevates the department’s deputy secretary to that position until a permanent replacement arrives. But VA’s deputy secretary, Thomas G. Bowman, has already been passed over by a White House that has wanted to overhaul the department’s leadership. Robert Wilkie, undersecretary of defense for personnel and readiness, is now running VA. The Federal Vacancies Reform Act of 1998 empowers the president to bypass a deputy and install anyone who has been confirmed by the Senate for any position “to perform the functions and duties of the vacant office temporarily in an acting capacity.”

The White House previously used that power to install Mick Mulvaney, the Senate-confirmed OMB director, to lead the Consumer Finance Protection Bureau, a move that is still being litigated by CFPB Deputy Director Leandra English. But Mulvaney’s predecessor, Richard Cordray, had resigned to run for governor of Ohio. Shulkin told The Washington Post on 30 MAR, as he told CNN on 1 APR, that he did not resign and was instead fired after being undermined by political appointees. “I don’t think that this was the president,” Shulkin told Tapper. “The president is committed to improving the care for veterans. These appointees had a belief that there was a different way to do that than I did … these individuals, when they didn’t see that their way was being adopted, used subversive techniques to change the leadership at VA.”

Shulkin’s description of what happened clashes with that of the Trump administration. On 30 MAR, Shulkin told The Post that he was told by White House Chief of Staff John F. Kelly that he was being pushed out. But 31 MAR, deputy White House press secretary Lindsay Walters told Politico that “Secretary Shulkin resigned from his position as Secretary of the Department of Veterans Affairs.” Asked on 1 APR about Shulkin’s description of what happened, Walters repeated that statement. The questions about Shulkin’s removal may well end up in court. Democrats, who, like Shulkin, believe that the Trump administration is attempting to elevate people who favor privatizing VA’s services, could sue over any major decisions made by Wilkie, arguing that the 1998 law on vacancies does not apply when appointees are fired.

“I would strongly suspect that, if you get rid of Shulkin, who opposed privatization, and you put Dr. Jackson in, that is what his mission will be,” Sen. Bernie Sanders (I-Vt.), who caucuses with Democrats, said 1 APR on CNN. “Without exception, the major veterans organizations say, we have got to strengthen VA, not dismember it, not privatize it. And I will do everything I can as a member of the veterans committee not to approve any nominee who is not going to strengthen VA and who will oppose privatization.” The prospect of an acting VA secretary making decisions and then facing legal action also worries some advocacy groups. “That uncertainty creates risk, which is a real problem,” said Max Stier, the president of the Partnership for Public Service. “I don’t believe any court has opined on this as of yet. It is uncertainty piled on top of uncertainty with real harm being caused to the VA and veterans.” [Source: The Washington Post | David Weigel | April 1, 2018 ++]

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VA Secretary Update 73 ► VA Confirmation Process Could Be Contentious

Ronny Jackson’s nomination to become the next Veterans Affairs secretary could become the most contentious confirmation process since the department was founded 30 years ago. But that’s also a fairly low bar. Since the department was elevated to a Cabinet-level post back in 1988, no senator has ever voted against a VA secretary pick. All of the confirmations have been unanimous or near-unanimous votes (with a handful of lawmakers absent), or procedural votes where no opposition was formally recorded. That includes former VA Secretary David Shulkin, confirmed by a 100-0 vote in February 2017. His total support from the Senate was frequently touted by President Donald Trump in public appearances, including one just a few weeks before Shulkin was fired by the president over social media on March 28.

In fact, no nominee for a confirmable department post over the last 30 years — totaling more than 150 individuals — has ever received a vote of opposition from the Senate, underscoring the non-partisan nature of VA work. That means even a single vote against Jackson’s confirmation could send a message of irreversible political division on the once seemingly untouchable approach to the department issues. Jackson, who retired from the Navy in late MAR as a rear admiral with 23 years of service, was a surprise nominee for the post. He’s an Iraq War veteran who served under three presidents as the top White House medical officer, and is best known for giving Trump a clear bill of health in January.

But little is known about his familiarity with the department, which boasts a budget this fiscal year of more than $186 billion and a staff of more than 370,000 employees. Senate Democrats have openly questioned the pick, and hinted he may not receive the same support as past nominees. “I admire Dr. Jackson’s service to the nation, but I don’t know if he is the right person to lead the VA,” Sen. Jack Reed (D-RI) and ranking member on the Senate Armed Services Committee, said in a statement last week. “The VA is a large and intricate agency that requires steadfast leadership and an understanding of how to run a complex organization.”

Sen. Tammy Duckworth (D-IL) is a combat-wounded Iraq War veteran and a frequent critic of the Trump administration. Like Reed, she promised to “carefully review Dr. Jackson’s qualifications to determine whether he has the best interests of our veterans at heart.” But she also accused Trump of wanting “to push VA down the dangerous path of privatization” and warned that “the next VA secretary must be able to protect the department from becoming consumed by partisan politics.” Former Senate Veterans’ Affairs Committee Chairman Bernie Sanders (I-VT) similarly said the Senate “should not approve any nominee for secretary who supports the privatization of the VA,” a charge which he has also leveled at Trump. The current top Democrat on the committee, Montana Sen. Jon Tester, said simply that he is “looking forward to meeting Admiral Jackson soon and seeing if he is up to the job.”

Few Republicans in the chamber have offered strong praise for Jackson thus far, though none have offered serious public concerns, either. No timetable has been set for the confirmation hearings. Senate officials still have

not received the formal nominating paperwork from the White House, which will start the background check and confirmation process. That work typically takes between one and two months. Senate leaders have said they hope to move quickly on the work to ensure a vote on Jackson’s nomination before the summer. Confirmation votes by the Senate on VA secretary nominees

David Shulkin, 100-0 (Feb. 13, 2017) Bob McDonald, 97-0 (July 29, 2014) Eric Shinseki, voice vote (Jan. 20, 2009) James Peake, voice vote (Dec. 14, 2007) John Nicholson, voice vote (April 11, 2003) Anthony Principi, 100-0 (Jan. 23, 2001) Togo West Jr., voice vote (April 28, 1998) Jesse Brown, unanimous consent (Jan. 23, 1993) Edward Derwinski, 94-0 (March 2, 1989)

[Source: NavyTimes | Leo Shane III | April 2, 2018 ++]

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VA Secretary Update 74 ► What The Law Calls For

Officials from one of the nation’s largest veterans groups are calling for President Donald Trump to remove the acting Veterans Affairs secretary from the post and instead hand over control to the department’s deputy secretary, saying that is “what the law calls for.” Leaders from AMVETS on 3 APR are sending a letter to the White House insisting the change is needed to calm fears of veterans and VA employees in the wake of the firing of David Shulkin last week. Shulkin, who had been one of Trump’s closest Cabinet members for much of 2017, was dismissed by the president over Twitter after nearly two months of controversy surrounding a watchdog report accusing him of ethics violations and subsequent infighting among political operatives in the administration.

Following Shulkin’s firing, Trump nominated White House physician Ronny Jackson as the next VA secretary, and Under Secretary of Defense for Personnel and Readiness Robert Wilkie to serve as acting secretary until the confirmation process is complete. But the announcement bypassed VA Deputy Secretary Tom Bowman, who was the next in line to take over the top leadership post. White House officials have not addressed the legal justification for a move, saying only that Wilkie has been working in the role since 29 MAR. On 3 APR, AMVETS Executive Director Joe Chenelly said administration officials erred in moving Wilkie from the Pentagon to VA headquarters, and asked for the “leadership situation” to be resolved immediately. “Tom Bowman is the person veterans need running the VA in this time of turmoil,” he said. “Tom is a retired Marine Corps colonel, highly respected on Capitol Hill and well regarded in the veterans community. This needs to happen now.”

Bowman was also the subject of possible firing rumors earlier this year, as opponents of Shulkin within the administration wrestled with how to deal with high-ranking VA officials they saw as opposing sweeping reform proposals to the department. Multiple sources within VA said they expect Bowman to resign within days, if he isn’t

fired first. Under current law, the president can fill leadership vacancies with any individual in cases where the current office holder resigns or is unable to perform the job.

If the Trump administration is found to be in violation of federal law in appointing Wilkie to the acting VA secretary post, it could call into question any department decisions he makes. That would mean that any new program starts, contract negotiations or policy changes may be vulnerable to future legal challenges. Chenelly said that uncertainty undermines Trump’s promises to improve and reform the department. Returning Wilkie to the Pentagon and elevating Bowman would limit confusion and bring stability to the now tumultuous department. Shulkin is the second VA secretary to be forced out of the office in the last four years. Including Wilkie and the other acting officials, six different men have helmed the $186 billion department since May 2014. Jackson, who’s nomination to the top VA job came as a surprise to most veterans groups, is expected to face confirmation hearings at the end of April or beginning of May. [Source: MilitaryTimes | Leo Shane III | April 3, 2018 ++]

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VAMC Washington DC Update 08 ► Director Replaced | Problems Still Exist

The director of the beleaguered Department of Veterans Affairs hospital in Washington D.C. was reassigned 9 APR amid ongoing problems at the hospital and an investigation into whether his appointment broke federal protocols. Retired Army Col. Larry Connell took over the hospital in April 2017, following a scathing report from the VA Inspector General’s Office about widespread, systematic failures that put veterans at risk. Former VA Secretary David Shulkin fired then-director Brian Hawkins and tapped Connell to reform the facility. In an email to VA staff 9 APR, Raymond Chung, acting director of the VA Capitol Health Care Network, announced that Connell’s tenure as temporary director of the DC hospital expired Saturday. Connell wasn’t asked to stay in the job longer, Chung wrote. Chung said the reason was that questions recently arose about whether correct hiring processes were followed when Connell was named to the post.

VA Press Secretary Curt Cashour confirmed to Stars and Stripes in March that the VA Office of Accountability and Whistleblower Protection was investigating whether protocols were violated. Citing a memo from the Office of Personnel Management, CNN reported that political influence could have played a role in his selection. Before taking the helm of the DC hospital, Connell worked on Trump’s transition team and was a special adviser to Shulkin. “Larry Connell’s temporary detail as acting director expired as scheduled 7 APR,” Chung wrote. “Although we had hoped for him to continue as VA D.C. medical center’s permanent director, issues regarding technical aspects of his initial appointment as acting director have arisen making it impossible at this time.” Connell was sent back to the VA central office to resume his previous role as senior adviser to the VA secretary. Charles Faselis, chief of staff of the hospital, will temporarily lead the facility, Chung wrote.

After the IG report April 2017, Faselis was Shulkin’s first choice to take over the hospital. However, Shulkin changed his mind and appointed Connell instead, announcing he wanted to bring in an outsider. Chung told VA staff that the decision to have Connell step down from the position was not made because of his performance. “This move has absolutely nothing to do with Larry’s performance, which has been phenomenal,” Chung wrote. “Over the past year, his efforts have been pivotal to the positive changes made here.”

The leadership shakeup came one day after Stars and Stripes reported that many of the problems existing at the hospital in April 2017 remained unresolved one year later, despite public reassurance from Connell and other VA leaders that real progress had been made. Stars and Stripes reviewed multiple inspection reports that described unsanitary conditions at the facility as recently as last month. A January report concluded the hospital still posed a risk to patient safety. Connell told reporters at a 7 MAR news conference that the facility had been scrubbed clean.

“This hospital is a different hospital today than it was back in April,” he said, suggesting that the problems had been addressed. “This is a great hospital for veterans to receive their health care,” he said. “I am so confident in the quality and safety of care at this facility, I enrolled here with my health care.”

Despite those claims, the VA Inspector General’s Office said the eight early recommendations it made in April 2017 to fix the DC hospital — which it said should be carried out “immediately”— had not been completed as last week. The IG asked the VA to ensure that supplies were available, create a working inventory system and hire key staff, among other recommendations. Multiple problems the IG discovered in April 2017 were echoed in a January 2018 report from the VA’s National Program Office for Sterile Processing. Inspectors found dirty syringe bottles and stopped their work to hold an immediate meeting with hospital leadership about the risk to patients. In March, an FDA inspector found a nonworking refrigerator in the hospital’s blood bank, keeping blood at room temperature, and workers weren’t always recording the temperature of blood when it was transported to the Children’s National Medical Center next door. On 5 MAR the FDA ordered the VA to resolve the issues.

In response to questions about ongoing troubles, Cashour said 5 APR that the DC hospital “has been aggressively addressing a number of identified concerns, but the facility’s problems didn’t emerge overnight and they won’t be solved overnight.” The uncertainty in the ranks at the DC hospital adds to an already turbulent leadership situation at the VA. [Source: Stars & Stripes | Nikki Wentling | April 9, 2018 ++ ]

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VAMC Washington DC Update 09 ► Problems Persist Despite Reported Resolutions

Department of Veterans Affairs documents detail seven canceled procedures caused by supply shortages in February and March at the VA hospital in Washington, contrary to the agency’s claims that the last one was in January. The documents, newly obtained by Stars and Stripes, outline seven instances of procedures being delayed or postponed because of supply shortages at the agency’s flagship hospital – four in February and three in March. In one case last month, a 69-year-old veteran was under anesthesia and a surgeon made an incision for his hip implant before medical workers realized they didn’t have the correct supplies – nails for the implant were mismatched. The procedure was eventually completed, but the mix-up led to the veteran being under sedation 30 minutes longer than expected. The VA launched a patient safety report, and the incident will go under peer review.

The VA Inspector General’s Office issued early findings in April 2017 of its investigation into the DC hospital, which serves about 93,000 veterans, revealing widespread problems that put veterans at risk. Inspectors found multiple procedures that were canceled because of a lack of supplies. In response to questions from Stars and Stripes about whether the problems were fixed, the VA claimed last week that the most recent canceled procedure because of supply shortages occurred in January. In that instance, the VA blamed delays at the Federal Express sorting station as the reason the hospital didn’t have the necessary supplies. “The last canceled procedure due to equipment/supply shortages occurred in January 2018,” VA Press Secretary Curt Cashour said in a written statement last week.

In response to questions 12 APR about the incidents in February and March, the VA claimed there were no procedures delayed or rescheduled because of a lack of supplies. Instead, Cashour argued six procedures were rescheduled during those two months because of “minor equipment sterilization issues.” The House Committee on Veterans’ Affairs is aware of cases of canceled procedures at the DC hospital after January, said Tiffany Haverly, committee spokeswoman. “The committee has received evidence of and is investigating canceled procedures in January, February and March,” she said. Incidents reported include:

According to a VA list of canceled procedures at the hospital, three dental procedures were delayed at the hospital in February because of unavailable supplies. One procedure was postponed for two weeks.

Another was pushed back 48 days, and the other 51 days. A colon surgery was canceled in February because of missing supplies and rescheduled for the following day. VA reports show that problems with supply shortages at the DC hospital continued into March.

In one case last month, a 54-year-old veteran arrived at the hospital for a hip replacement. While he was in the waiting room, medical workers discovered their equipment wasn’t sterile. The procedure was rescheduled for the following week.

Another day in March, the hospital scheduled nine veterans for the same outpatient procedure but had only enough supplies for seven. A 69-year-old veteran had his appointment rescheduled for a later date. An 80-year-old veteran chose to wait for equipment to be sterilized, and he had his procedure later the same day. The VA said a “communication breakdown” contributed to the shortage, as well as the heavy workload on the department responsible for sterilizing medical supplies. According to a report from January, the VA’s National Program Office for Sterile Processing found key staff vacancies in that department. Cashour said last week that the hospital had hired nine additional permanent staff members for the team.

On March 26, the hospital’s medical supply vendor failed to make a delivery – leading to “critical medical supply shortages,” according to a report. Hospital leadership was notified, and supplies were pulled from other departments for time-sensitive surgeries. The situation prompted the hospital to find backup vendors that could provide emergency medical supplies in case it happens again.

The instances of supply shortages and canceled procedures in the past two months are analogous of problems the IG described one year ago, indicating the issues persist at the DC hospital — located just four miles from VA headquarters — despite recent claims from the VA of substantial progress. In a more comprehensive report the IG released last month, inspectors cited multiple incidents in 2017 when staff had to leave the medical center to borrow supplies from a private hospital across the street. Inspectors reviewed 39 cases of canceled procedures because of supply shortages from 2015 to 2017. In some cases, veterans were unnecessarily hospitalized overnight because they were waiting for supplies. Surgeons sometimes were forced to use instruments that were available, instead of the ones they preferred, the IG reported.

Inspectors found no evidence that patients were harmed because of the lack of supplies, and they credited staff who “worked around these challenges and improvised as necessary to provide veterans with the best possible services under the circumstances.” The IG and the Office of Special Counsel would not confirm whether they are investigating continued shortages and canceled procedures at the hospital. The House Committee on Veterans’ Affairs is planning an oversight hearing as early as next month. [Source: Stars And Stripes | Nikki Wentling | April 12, 2018 ++]

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Vet Green Alert ► Wisconsin System For Missing Vulnerable Veterans

Wisconsin might become the first state in the nation to create a Green Alert system for missing vulnerable veterans, reports the Milwaukee Journal Sentinel. The system would be similar to state Amber and Silver alerts for missing children and older adults, respectively. The state Senate passed legislation to create the system in late JAN, and the state Assembly was expected to take up the bill in February. “We’re hoping this goes national,” state Democratic Sen. LaTonya Johnson told the newspaper. Johnson had introduced the bill. “Veterans give so much.” Johnson said. Referring to an Air Force veteran whose death prompted her to introduce the bill, she said that the vet had “served (three) tours and he came home safe. If he made it home safe we should have done everything to make sure he was made whole.”

For 18 days last spring, U.S. Air Force veteran Corey Adams of Milwaukee was missing, but it took eight days before he met the criteria to warrant an official law enforcement search. Adams' body was recovered in a pond just a

mile from his home. His family, which notified authorities immediately when he went missing, went to State Sen. LaTonya Johnson and asked for help, in hopes that no other family would have to go through such a traumatic event.

Republican state Assemblyman Joel Kleefisch, a sponsor of the Corey Adams Searchlight Act, said he expected it to pass the Assembly and be on Gov. Scott Walker’s desk by the end of February. The bill has since been enacted into law. “I will not be surprised if we see Green Alert in every state of the union in the next three to four years,” Kleefisch told the newspaper. [Source: Wisconsin State Journal | Ken Chamberlain | January 31, 2018 ++]****************************************************************************************

PTSD Update 244 ► Should Seeking VA Help Impact on Vet's Gun Ownership Right?

Adam Lingo, a retired Army staff sergeant, walked across 11 states last year, flanked by men who had become like brothers while serving together in Iraq. They made the nearly 3,000-mile journey to honor their dead and ― more pressingly ― help other veterans still struggling. “We started doing the numbers and I think we lost more guys to suicide in our unit than we did while we were in combat,” the 42-year-old veteran told HuffPost, referring to the men who served in his 1-24 infantry unit in the early 2000s. “It is an epidemic and it’s something I don’t think the [Department of Veteran Affairs] is paying enough attention to,” Lingo said. “Honestly, I don’t think they know what to do.”

Lingo is referring to the acute mental health crisis facing veterans across the country. On average, 20 veterans die by suicide each day. And studies show that between 13 to 30 percent of Iraq and Afghanistan veterans have post-traumatic stress disorder, a mental health disorder that typically manifests after someone experiences or witnesses a life-threatening event. But only about half of the vets from these wars who might need mental health treatment ― not only for PTSD but also substance use and depression ― actually seek it through the VA or private health care. To receive health care from the VA, vets must undergo PTSD screening, and those who are diagnosed with it or other conditions are eligible to receive monetary disability benefits.

During his trek, Lingo noticed a pattern among veterans who needed help for mental illnesses: They were afraid to reach out for it. Many of the vets he spoke to were distrustful of the government, and he described a common refrain he heard along the way: ”‘Hey, if I do go and I register to get help and they do diagnose me with PTSD, am I gonna be able to keep my guns?’” Veterans face several barriers to treatment for mental health illnesses like PTSD, including long waiting lists for care with the VA and the social stigma of carrying a mental health diagnosis. But with nearly half of all veterans owning one or more firearms, the fear that seeking help for PTSD could result in losing access to their guns proves to be a significant barrier to care. And it’s an obstacle fraught with danger. PTSD increases a veteran’s risk of substance abuse, severe depression, anxiety, death by suicide and also has a small but significant link to domestic violence. Left untreated, these risks are even higher. One study found that U.S. army service members who died by suicide from 2001 to 2009 were nearly 13 times more likely to have a PTSD diagnosis.

I get asked that question more than once every single week: ‘If I file a claim for PTSD are they going to take my guns?’” Heather E. Vanhoose, veteran attorney. Vanhoose, lead veteran attorney for the Jan Dils Law Firm, has often heard concerns related to PTSD and gun ownership during her 11 years representing veterans. “It’s very real among my client population,” said Vanhoose, who is based in West Virginia but handles cases nationwide. “I get asked that question more than once every single week: ‘If I file a claim for PTSD are they going to take my guns?’” She added that none of her clients have ever had any issues with owning or buying a gun because of their PTSD classification.

The fear is evident online as well, with similar questions popping up on Reddit, military forums and blogs. While some of these platforms, including a blog published by Vanhoose’s law firm, attempt to quell veterans’ concerns, others, like the NRA’s America’s First Freedom magazine, have stoked fears that veterans’ gun rights are under siege. But veterans’ concerns aren’t irrational, either. The VA has the ability to deem a veteran “mentally

incompetent” to handle monetary benefits through its fiduciary program ― a decision that would bar the beneficiary from possessing or purchasing a gun. An incompetent rating, tied to the management of VA-allocated monetary benefits, results in the appointment of a trustee on the veteran’s behalf. Then, in compliance with the Brady Handgun Violence Prevention Act, the agency sends the names of incompetent beneficiaries to the FBI, which in turn places the names into the National Instant Criminal Background Check System (NICS). A name in the NICS is what could prevent a veteran from buying, transporting and owning a firearm.

The agency’s indirect impact on some veterans’ ability to own and purchase firearms is a point of contention for some ardent 2nd Amendment supporters. Last year, Rep. Phil Roe (R-TN) introduced a controversial bill that would still allow veterans deemed mentally incompetent to own a firearm unless a judge ordered otherwise. Those who opposed the legislation pointed to the high rates of firearm suicide among veterans. While a mental incompetence designation is a possibility for some vets, a misunderstanding of the VA’s protocol may be preventing many more from getting the mental health care they need. A VA spokesperson told HuffPost that veterans’ concerns of losing their firearms due to a PTSD diagnosis are “unfounded.”

Still, the fear persists ― particularly among veterans hoping to work or who are already working in law enforcement jobs, the vast majority of which require that a person be legally able to possess a gun. Mike, whose name has been changed because he did not have permission from his police department to speak to the press, is an Oregon-based police officer of almost a decade and an Iraq War vet. He told HuffPost that at the beginning of his career he was afraid to seek help for his PTSD because he thought it could mean losing his job. “There is definitely some stigma, with being a police officer and being diagnosed with PTSD,” he said, adding that he only sought help after an injury led him to question whether he would be let go from his department anyway.

The VA offered him benefits and regular counseling, and he now focuses on reaching out to veterans who have yet to seek help. Mike said he answers a call about a distressed veteran almost weekly. The men and women he comes across are often suicidal ― sometimes they haven’t slept in days, a symptom of their PTSD. The police officer must often peel back the sleeve of his uniform to reveal the infantry badge inked on his forearm ― a tattoo that has helped him make immediate, life-saving connections with many vets reluctant to speak about their experiences and fears. “I go to these calls and one of my first questions while we’re talking is, ‘Why haven’t you gone, before now, to seek help?’” Mike said. “It is a common theme that they are afraid of losing the right to own firearms.”

When The Fear Becomes RealSergeant Eddie Montoya, 40, was sitting next to his company commander just minutes before a suicide bomber attacked their mess hall tent near Mosul in December 2004. In the wake of the explosion, the former combat medic helped tend to the wounded and identify bodies. The bombing, which killed 22 people and left dozens injured, was one of the deadliest attacks on U.S. forces during the war. It was also the last time Montoya and Lingo saw four of their fellow soldiers, including commander Capt. William Jacobsen. After 16 years in the army, Montoya received a PTSD diagnosis. It had no impact on his ability to purchase or own guns legally, but two subsequent experiences with the VA in 2015 almost did.

It began with his drinking. Once stateside, the veteran self-medicated with alcohol. “I think I was just trying to numb the pain,” Montoya, who now lives in San Bernardino, California, told HuffPost. But when he sought help to quit drinking at a VA clinic, Montoya said he ended up in a psychiatric hold for two days because staff confused his emotional state with being suicidal. “It was degrading and embarrassing,” he added. (Citing patient privacy concerns, the VA was unable to corroborate why Montoya was put in a psychiatric hold.) “I’ve done a couple of tours, I’ve seen a lot of stuff. My mind isn’t what I would call normal,” Montoya said. “But, I’m not crazy. I’m not homicidal. I’m not suicidal.” It’s a distinction that Montoya feels passionate about making, particularly due to how often veterans are erroneously portrayed as dangerous or “ticking-time bombs.”

Circumstances were further complicated months later when Montoya sought to increase his VA benefits after he quit drinking (the veteran told HuffPost he’s currently almost three years sober). Montoya went through a procedural

psychological evaluation during which he said a doctor asked him about his finances. The vet said he told the doctor that he allows his wife, a social worker, to manage household finances because she helped him get out of debt and get his credit score over 700. A couple of weeks later, he received a written notice from the VA referencing his psychological evaluation and informing him that the agency was considering designating him incompetent, putting his firearm possession rights at risk.

There remains a lack of clarity surrounding the threshold of injury or disease that could lead the VA to declare a veteran mentally incompetent, but the agency told HuffPost the decision is not directly connected to a single diagnosis. “While a mental disorder, such as PTSD, may be considered a disease under 38 C.F.R. § 3.353(a), the fact that an individual has been diagnosed by a VA physician as having a mental disorder ― or even that the individual has been found to be disabled for purposes of VA disability compensation ― would not establish that the individual lacks the mental capacity to manage his or her own affairs,” VA press secretary Curt Cashour said. Veterans are given a due process period to fight a proposed incompetence rating. Montoya was told he had 60 days to respond with evidence to prove he did not need a fiduciary.

“My attorney fought it,” Montoya said. “They ended up increasing my benefits from 50 to 100 percent and they took away that letter saying they wanted to seize my weapons and give me a trust for my disability money.” Montoya added that at no point during the three to four-month process did anyone show up attempting to seize his firearms. He also said he’s had no issues purchasing a gun since. Last year, however, Montoya said he was denied a concealed carry permit by the San Bernardino County Sheriff’s Department. He said an officer told him it was due to his medical history and the veteran suspects it has something to do with his PTSD or his time in the psychiatric hold. “I was reaching out to a ‘trusted’ source and got penalized for it,” Montoya speculated. “This is why vets won’t reach out.”

The San Bernardino County Sheriff’s Department did not respond to questions about Montoya’s specific case but Sergeant Matt Yost told HuffPost applicants are issued a concealed weapons permit based on good moral character, residency and good cause per California law. “The Sheriff’s Department generally does not request medical records from our applicants,” Yost added, but applicants do sign a notarized authorization to release certain medical information, including psychological records, in accordance to state law.

Deadly ConsequencesSome veterans forego mental health treatment over the possibility they’ll lose their gun ownership rights, but leaving PTSD untreated is dangerous. In particular, vets who don’t seek treatment for PTSD could run a higher risk of dying by suicide, forensic psychiatrist Dr. Elspeth Cameron Ritchie told HuffPost. “PTSD symptoms wax and wane, but certainly not getting help can make things worse,” she said, adding that there’s a very close link between PTSD and depression. Out of the average 20 veteran suicides per day, only 30 percent are users of VA health services. Guns are by far the most common method of suicide among veterans, with approximately 67 percent of all deaths by suicide being a result of firearm injuries.

It’s a grim reality Lingo, Montoya and the men in their infantry unit have witnessed up close over the years ― and the reason the veterans set up the nonprofit Brotherhood Bridge, which seeks to help veterans integrate back into civilian life, after their “Walk of Life.” “I’ve had tons of friends that had guns to their head ― I did, at one point ― so I understand it,” Lingo said. He described his own “Russian roulette”-style incident as something that happened “years ago” while he was still in the army. Lingo said his past experience with depression is one reason he doesn’t currently own a gun. “I wouldn’t want to use it on myself,” he said, adding that he also simply doesn’t feel he needs one at the moment. “Now, if I ever felt like I needed one, I would go and get one … I feel like I should be able to have a gun. I just choose not to have a gun.”

The sort of nuance that Lingo describes is difficult to achieve from a policy standout ― as experts and policymakers seek to both keep veterans safe and protect their ability to own guns. And Dr. Ritchie said there’s no easy solution when it comes to creating guidelines that delineate who is fit to own a gun and who is not in relation to mental health. “I think it’s important to talk about it as an issue and to look at the data that exists rather than classify

people either as ticking time bombs or ‘everybody is just fine’,” she said. Mike agrees. “How many wars has America been in? And this has been an issue after every single war we’ve ever gone to,” the Oregon cop said. “Still today, I’ll go to calls of old Vietnam veterans and they’re still having issues with PTSD and they’ve buried it with alcoholism, drugs or other things ... You’d think we’d have figured it out by now.” [Source: Huff Post | Carolina Moreno | April 9, 2018 ++]

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Vet Jobs Update 231 ► Federal Government

Federal government representatives talk about their commitment in hiring veterans, but how well do they really do? Not bad, actually. In fiscal 2016 (the latest year for which data is available), roughly one-quarter to one-half of the workers at the largest agencies, such as the departments of Defense and Homeland Security, are military veterans, according to the Office of Personnel Management. Other agencies, including some of the relatively smaller ones, such as AID and EPA, employ a significantly smaller percentage of veterans. There’s been relatively little variation from fiscal 2014 to 2016 in the percentages, as demonstrated in the chart below. And overall, 31.1 percent of federal workers were veterans in fiscal 2016, only a slight bump from 2012 when veterans made up 29.7 percent of the workforce.

[Source: Federal Times | Ken Chamberlain | April 7, 2018 ++]

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Did You Know (01) ► Items of Interest to Vets

Reversing a long-held position, the Department of Veterans Affairs (VA) now says Air Force reservists who became ill after being exposed to Agent Orange residue while working on planes after the Vietnam War should be eligible for disability benefits. The VA said it has been working to finalize a rule that could cover more than 2,000 military personnel who flew or worked on Fairchild C-123 aircraft in the U.S. from 1972 to 1982. Many of the Vietnam-era planes, used by the reservists for medical and cargo transport, had sprayed millions of gallons of herbicide during the 1955-1975 military conflict in Southeast Asia. If the White House Office of Management and Budget approves the change, it would be the first time the VA had established a special category of Agent Orange exposure for

military personnel without “boots on the ground” or inland waterways service in Vietnam. That could open the VA to renewed claims by thousands of other veterans who say they were exposed to Agent Orange in less direct circumstances, such as on the open sea.

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The Semper Fi Fund, a 501(c)(3) nonprofit, and its program America's Fund, are set up to provide immediate financial assistance and lifetime support for wounded, critically-ill and injured members of the U.S. Armed Forces and their families. Since establishing the Semper Fi Fund in 2004, they've issued more than 71,500 grants, totaling close to $91 million in assistance to over 11,500 heroes and their families.  For assistance call 760-725-3680.

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At http://www.militarydisabilitymadeeasy.com you can find out about the accuracy of your VA rated disability.  The site is comprised of a team of military medical professionals with experience ranging from health care administration to analyzing military medical laws, policies, and directives, and reporting to congressional committees.

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Project 112/SHAD (Shipboard Hazard and Defense) is the name of the program for both shipboard and land-based biological and chemical testing conducted by the U.S. military between 1962 – 1973.VA will provide physical examinations to veterans who participated in the testing. Veterans will receive medical care free of charge for conditions related to exposure. Veterans may be eligible for disability compensation if they have a service-related disability and were discharged under other than dishonorable conditions.VA does not presume by regulation that any specific disabilities are related to participation in Project 112/SHAD. Veterans’ claims are decided on a case-by-case basis.

VA presumes amyotrophic lateral sclerosis (ALS) diagnosed in all Veterans with 90 days or more continuous active military service is related to their service, although ALS is not related to Project 112/SHAD.Surviving spouses, dependent children and dependent parents of Veterans who died from health problems related to participation in Project 112/SHAD may be eligible for health care, compensation, education, and home loan benefits.

[Source: http://www.veteranprograms.com/did-you-know2.html | USVCP | April 15, 2018 ++]

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Vet Deportations Update 20 ► ICE Wrongly Interpreting SECDEF Directive

Immigration and Customs Enforcement (ICE) appears to have ignored a directive from Defense Secretary Jim Mattis to prevent the deportation of noncitizen troops and veterans, seeking to remove a Chinese immigrant despite laws that allow veterans with honorable service to naturalize, court filings show. Xilong Zhu, 27, who came from China in 2009 to attend college in the United States, enlisted in the Army and was caught in an immigration dragnet involving a fake university set up by the Department of Homeland Security to catch brokers of fraudulent student visas.

Zhu paid tuition to the University of Northern New Jersey, created by DHS to appear as a real school, long enough to ship to basic training using the legal status gained from a student visa issued to attend that school. Then ICE found him and asked the Army to release him for alleged visa fraud. He left Fort Benning, Ga., on Nov. 16,

2016, in handcuffs as an honorably discharged veteran. He was detained for three weeks and released. Zhu is waiting to hear a judge in Seattle rule in his removal proceedings. His attorney says his client is a victim of federal entrapment.

Zhu’s case comes amid Trump administration pressure on immigration judges to speed up deportation proceedings in an apparent move to adjudicate more removals, aligning with President Trump’s stated goals. But it also comes after Mattis said he would protect certain immigrant recruits who enlist through a program designed to trade fast-tracked citizenship for medical and language skills. Those assurances followed sustained controversy over how the Pentagon has exposed more than a thousand foreign-born recruits to deportation. A background-screening logjam began in late 2016 when fears of insider threats slowed clearances to a glacial pace.

“Anyone with an honorable discharge … will not be subject to any kind of deportation,” Mattis told reporters at the Pentagon in February, describing exceptions for criminals and anyone who has been authorized for deportation in an agreement he said was made with DHS Secretary Kirstjen Nielsen. Zhu’s attorney, retired Army officer Margaret Stock, told The Washington Post those exceptions do not apply to him. DHS referred queries to U.S. Citizenship and Immigration Services, which did not respond to a request for comment. ICE did not immediately return comment. But through court documents, ICE has interpreted the Mattis directive applies to a narrow group of foreign recruits that exclude Zhu. It’s unclear whether ICE consulted with the Pentagon on the subject, or if the agency has moved to deport other immigrant recruits since Mattis spoke in February.

Zhu graduated from basic training on June 9, 2016, and was handed over to ICE custody months later, after the Army lost a battle to retain him, Stock said. Zhu was included in a group of “holdovers,” an Army term he disdains that refers to soldiers who fail training. That wasn’t him. “It made me nauseous to be lumped into that group,” he told The Post.

How Zhu got in his predicament is a strange, bureaucratic odyssey after he graduated from Beloit College in Wisconsin in 2013. He wanted to become a U.S. citizen, so he decided to enlist through the Military Accessions Vital to the National Interest (MAVNI) program that his father in China had read about. It trades expedited citizenship for language and medical skills in short supply among U.S.-born recruits. The program was designed by Stock and implemented in 2009, with more than 10,000 troops rotating through since then. But it was temporarily shelved at the time Zhu tried to enlist in 2013, so he needed a way to keep his status. U.S. Quickly, a company that provides education consultation to immigrants, told him that the University of Northern New Jersey was approved by DHS to authorize curricular practical training, a type of school credit for his work at Apple as a customer support technician.

Zhu’s enlistment contract was approved by USCIS on the basis he attended a school DHS itself set up as a sting operation.

DHS certified his studies, and he paid the university $8,000. He took his new I-20 form as proof of lawful status to obtain a driver’s license, Stock said, all while the sting operation fooled students. As part of Operation Triple Lindy, undercover agents posed as university administrators, and the school website promised “an exceptional educational experience.” U.S. Quickly did not return a request for comment. “Nobody knew the school was fake,” Stock said, including Zhu, who said it would be “suicide” to knowingly attend a fake school given that he would soon be screened by government agencies, including DHS.

A class-action lawsuit of students alleging entrapment was dismissed in October because ICE had not determined whether it was taking further action. He was released after seven months of service, according to court documents obtained by The Post. His driver’s license from Washington state has “veteran” printed on it. His status should mean that he can proceed with citizenship. Laws in place since World War I say noncitizens who leave the military under “honorable conditions” are eligible for naturalization. But ICE disputes the circumstances.

Jordan L. Jones, an ICE assistant chief counsel, said in a Seattle federal immigration court filing on 29 MAR that Mattis was actually referring only to recruits who came to the country illegally as children and enlisted later through DACA as those who are protected. Zhu is removable “despite his honorable discharge,” Jones wrote, adding the judge, John F. Walsh, cannot dismiss proceedings. Stock said Mattis could not have meant only DACA recipients because they overwhelmingly naturalize in the military and are only a small portion of foreign recruits who enlist. “They’re ignoring what Mattis said,” Stock said. When asked to clarify Mattis’s remarks, Pentagon spokesman Maj. David Eastburn referred to the February statement. Mattis previously said he wants to preserve the MAVNI program.

Zhu, a native speaker of Mandarin Chinese, could have proved useful in uniform as the U.S. military focuses on countering an increasingly aggressive China and Russia. Instead, deportation looms, including threats from Zhu’s

former homeland. A former State Department official told The Post in July that Chinese-born U.S. military recruits who are deported to their native land may face harsh confinement and interrogation. If deported, Zhu would probably return to his home town in Chongqing. It features an unusual memorial for a communist nation: a bust of Army Gen. Joseph Stilwell, who commanded U.S. and Chinese forces from the city during World War II. A library named after President Franklin D. Roosevelt is also there, Zhu said. But the city also brims with hostility toward the United States.

Zhu said that after he graduated in 2013, local authorities investigated allegations of corruption involving his father, a businessman. They obtained his phone and viewed instant messages in which he and his son discussed Zhu’s future military service. The authorities were suspicious and called his son unpatriotic, then let him go without charges after 48 hours, Zhu said. The episode rattled his father. “If you get a chance,” he told his son, “don’t ever think about coming back.” [Source: The Washington Post | Alex Horton April 4, 2018 ++]

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Vet Fraud & Abuse ► Reported 01 thru 15 APR 2017

Grave Robber Historian Sentenced: The VFW was one of only two organizations invited by the federal government to speak at the sentencing hearing of Antonin DeHays, a French historian and archivist, who over a five-year period sold more than 430 World War II items he had stolen from the National Archives. Representing the other organization — the National Archives — was Archivist of the United States David Ferriero. Stolen were 297 dog tags and 136 other items, to include ID cards, a Bible, photos and personal letters. The items were originally obtained from the bodies of dead or captured Americans, mostly as the result of military aircraft crashes in Nazi-held territory. The Germans kept meticulous records, which were later seized by the Allies after the war. On Monday, U.S. District Court Judge Theodore Chuang in Maryland sentenced DeHays to 364 days in prison for the theft of government records and ordered him to pay more than $43,000 in restitution to the unwitting buyers who purchased the stolen goods. Said VFW spokesman Joe Davis, “DeHays isn’t just a thief, he’s a grave robber who abused the professional courtesies extended to fellow historians as a means to steal for personal gain.” About 95 percent of the stolen items have been recovered so far. [Source: VFW Action Corps Weekly | April 13, 2018 ++]

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Drug Cost Increases Update 14 ► S.2155 | Know the Lowest Price Act

New legislation launched by U.S. Sen. Debbie Stabenow (D-MI) on 14 MAR would lower prescription drug costs in a three-pronged effort involving gag clauses, negotiations, and import regulation allowances. The Know the Lowest Price Act, which strikes gag clauses that prohibit pharmacists from telling customers they could pay less for their prescription when paying out of pocket. The other two prongs, for which no action has been taken to date on, include:

The Empowering Medicare Senior to Negotiate Drug Prices Act (S.1688) introduced 1 AUG 2017 by Sen. Amy Klobuche. If passed this would allow the Secretary of Health and Human Services to negotiate with drug companies on drug price discounts–something currently banned outright.

The Affordable and Safe Prescription Drug Importation Act (S.469) introduced 28 FEB 2017 by Sen. Bernard Sanders. If passed this would provide an authorization for that same Secretary to issue regulations which permit wholesalers, licensed U.S. pharmacies and individuals alike to import drugs from licenses Canadian sellers manufacturers at Food and Drug Administration inspected facilities.

“I continue to stand up to the drug lobbyists and special interests because it is morally wrong to keep prices for your medications so high,” Stabenow said. “The passage of my legislation would make a major difference for Michigan families.” A recent AARP study found that prices for the most popular brand-name drugs rose 208 percent between 2008 and 2016. [Source: The Peninsula | Chris Galfor | April 03, 2018 ++]

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Generic Drug Pricing Update 05 ► S.2553, S.1688, & S.469 | Lowering Cost

U.S. Senator Debbie Stabenow (D-MI) unveiled more new legislation aimed at lowering the cost of prescription drugs during events across the state in Detroit, Flint, Lansing, Grand Rapids, Ishpeming, and Traverse City. Americans pay – by far – the highest prices in the world for prescription drugs. Prices for the most popular brand-name drugs have risen 208% from 2008 to 2016, according to AARP. “I continue to stand up to the drug lobbyists and special interests because it is morally wrong to keep prices for your medications so high,” said Senator Stabenow. “The passage of my legislation would make a major difference for Michigan families.” Pharmaceutial and health product lobbying reached $279 million last year, more than any other industry. Stabenow is announcing three pieces of legislation that will combat rising prescription drug costs:

The bipartisan Know the Lowest Price Act (S.2553) cracks down on outrageous gag clauses that stop pharmacists from telling customers that they could pay less for their prescription if they pay out of pocket.

The Empowering Medicare Seniors to Negotiate Drug Prices Act (S.1688) would allow the Secretary of Health and Human Services to directly negotiate with drug companies for price discounts of their drugs, which is banned under current law.

The Affordable and Safe Prescription Drug Importation Act (S.469) authorizes the Secretary of Health and Human Services to issue regulations permitting wholesalers, licensed U.S. pharmacies, and individuals to import drugs from licensed Canadian sellers that are manufactured at facilities inspected by the Food and Drug Administration. Currently, Americans pay about 40 percent more on prescriptions per person than Canadians do.

At https://www.stabenow.senate.gov/about/issues/lowering-costs-of-prescription-drugs can be found more details on Senator Stabenow’s prescription drugs legislation. [Source: CBS Minnesota | Susan-Elizabeth Littlefield | March 25, 2018 ++]

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VA Emergency Care Update 11 ► S.2131 | Newborn Emergency Treatment Act

The VA Newborn Emergency Treatment Act would authorize the VA Secretary to provide payment for emergency transportation in cases where a newborn of a woman veteran requires treatment at a more specialized medical facility.  If a veteran mother and infant are transported to another medical facility together, VA is authorized to pay for that transportation. Currently, VA lacks clear authority to pay for the transportation of the newborn infant alone. However, this legislation would provide such authority.

In concurrence with the Disabled American Veterans (DAV) organization's resolution 225, which calls for enhancing women's health care services, DAV believes women veterans deserve a robust maternity care benefit that allows their infants basic transportation coverage for care that would be covered under Medicaid and most private insurance plans.  Maternity care is an important benefit to the large portion of women veterans who use VA services. Many women veterans for whom VA coordinates maternity care are at high-risk for pregnancy complications, including pre-term labor or low-birth weight newborns, because of service-connected conditions.  Infants born to these mothers often require more specialized and intensive services after birth; however, not all hospitals have such services available and transportation for the infant, but not necessarily the mother becomes necessary.

DAV is requesting your support to help them ensure that VA covers the expense of emergency transportation for the newborns of women veterans. Towards this they have prepared a letter to use to askyour Senators to support S. 2131, the VA Newborn Emergency Treatment Act. At the DAV Commander's Action Network Take Action you can review the letter and, if you agree, have it automatically sent to your legislator.   [Source: Disabled American Veterans | Delphine Metcalf-Foste | April 11, 2018 ++]

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B-1 Bomber Update 02 ► Deployed to Middle East Again To Take Over Strike Missions

The B-1B Lancer is back in the Middle East for the first time in nearly two-and-a-half years to take over strike missions from B-52 Stratofortress bombers. The non-nuclear bombers from Ellsworth Air Force Base, South Dakota, arrived at Al Udeid Air Base, Qatar, on 31 MAR, according to social media posts from Air Forces Central Command (AFCENT). The Lancers will be primarily focused on Operation Inherent Resolve, the fight against ISIS in Iraq and Syria, and Operation Freedom Sentinel in Afghanistan, Air AFCENT said. The command would not give details on how many bombers are involved or on the duration of the mission.

"Following two years supporting U.S. Pacific Command requirements, the B-1 returns to the U.S. Central Command [area of responsibility] where it will take over bomber duty from the venerable B-52 Stratofortress," AFCENT posted on Twitter. "The [B-52] will soon depart following two years in which it played an instrumental role in the fights against ISIS and the Taliban, clocking more than 1,800 sorties and approximately 12,000 weapons released against targets in Iraq, Syria and Afghanistan," the message continued. The long-range B-52 bombers, known as "Big Ugly Fat Fellow," or BUFF, transitioned back to the Pacific earlier this year, replacing the B-1Bs for an 18-month-long mission. The B-1 took over that mission in 2016, marking the first time since 2006 that Lancers had been housed at Andersen Air Force Base, Guam. In December, B-1 pilots and crew members told Military.com they were training round-the-clock for the evolving battlespace in the Middle East.

Military.com sat down with leaders from Air Force Global Strike Command's 7th Bomb Wing, responsible for producing combat-ready aircrews in the Air Force's only formal B-1B training unit, during a trip to Dyess Air Force Base, Texas, in December. The trip also included a ride in the B-1B over training ranges in New Mexico. The aircraft, known as the "Bone," left the U.S. Central Command area of responsibility in early 2016 and was replaced by B-52 Stratofortress bombers at Al Udeid that April. Air Force officials at the time said the B-1B's return stateside was crucial to upgrade the fleet with the latest Integrated Battle Station, or IBS. The IBS upgrade has been incorporated into more than half of the 62 total aircraft. Before its 2016 departure, the aircraft deployed the most weapons of any aircraft involved in the anti-ISIS campaign, according to statistics provided to Air Force Times. The

B-1B was responsible for almost 40 percent of Air Force bombs on Islamic State targets, according to service statistics.

Now, even as the air campaign against ISIS steadily winds down, it still requires "surgical strikes," or precision-guided bombs on target as the battlespace continues to shrink, Maj. Charles "Astro" Kilchrist, chief of training for the 9th Bomb Squadron, said in December. Meanwhile, the U.S. has increased airstrikes in Afghanistan in support of Operation Freedom’s Sentinel. The Air Force has been shifting more MQ-9 Reaper drones for Overwatch and strike missions; additional combat search-and-rescue squadrons; and A-10C Thunderbolt II ground attack aircraft, which recently arrived at Kandahar Airfield, for close-air support strikes. In January, the aircraft joined F-16 Fighting Falcon fighter jets, C-130J Hercules mobility airlift, EC-130H Compass Call electronic attack aircraft, and other planes already in the AOR supporting these operations from Bagram Airfield. [Military.com | Oriana Pawlyk | April 2, 2018 ++]

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Military Spouse Deportation Update 05 ► Estimated Up to 11,800 Active Duty Impacted

As many as 11,800 currently serving in the U.S. military are dealing with a spouse or family member who is facing deportation, a national immigration advocacy group announced 30 MAR. No previous estimate, official or unofficial, has been available on just how many of the 1 million married military members currently on active duty, National Guard or Reserve status may be dealing with the stress of having a spouse, dependent or parent deported. It’s also not a number that can be easily checked, or verified, because neither DoD, the Department of Homeland Security nor U.S. Immigration and Customs Enforcement tracks military status in immigration proceedings.

American Families United, a non-profit immigration advocacy group, calculated the estimate using 2011 U.S. Census statistics, which found that 6.3 percent of the 129 million married Americans are married to foreign-born spouses. The Pew Research Center found that one in four of those foreign-born spouses are in the country illegally. About 75 percent of that population comes from countries like Mexico, where if they entered illegally, they have a harder time obtaining legal status, as opposed to a person from Europe who might have overstayed a visa, said American Families United President Randall Emery.

“So we derived the total of military (active and reserves) married to people with inadmissibility-type immigration issues by taking the total (1 million), multiplying by the national percentage of foreign-born (6.3 percent, so 63,000 current U.S. military are married to immigrants), and then the 25 percent of the total which have problems with immigration law: 15,750. Of that, Pew’s data indicates 75 percent are from sources characterized by entry without inspection and similar issues, that would be about 11,800,” Emery said.

While it may not be exact, AFU generated the military estimate to “create awareness and get some of these legislators who say they support the military to actually act on it” and recognize that this is a bigger military problem than previously thought, said Nancy Kuznetsov, the group’s military liaison. That’s become more important in the last year, both Emery and Kuznetsov said, as President Donald Trump’s administration has taken a harder line on immigration enforcement. “It used to be veterans we’d see more frequently,” Kuznetsov said. “We’re now seeing an uptick in active-duty people.” While the active duty members themselves are protected — because in order to enlist a service member has to show proof that they are in the country legally — their undocumented spouses are not.

An earlier “parole in place” program that was previously championed by Vice President Mike Pence to give relief to military families is no longer being utilized due to stricter enforcement of deportation proceedings under Trump. That’s meant more military families calling the group for assistance, Emery said. “Recently, we’ve seen an increase in cases of both active-duty personnel and veterans who have been failed by immigration law,” Emery said. “These estimates give us perspective on the problem.” Immigration and Customs Enforcement (ICE) removed

61,094 people in fiscal year 2017, compared with 44,512 in fiscal year 2016, a 37 percent increase, according to Department of Homeland Security data.

Military Times has spoken to more than a dozen military families who reached out after hearing about 7th Special Forces Group veteran Bob Crawford and his wife Elia, who was facing deportation. After intense media interest, DHS dropped removal proceedings against her. When asked, neither DoD, DHS nor ICE could say how many military families are facing deportation proceedings, because it’s not data they track or report, While an ICE official said the agency “respects the service and sacrifice of those in military service, and is very deliberate in its review of cases involving U.S. military veterans,” the agency does not track military status in its removal statistics, the official said.

ICE referred queries on how many military families were facing removal proceedings to the Department of Justice’s Executive Office for Immigration Review. But that court “does not track military status among respondents or their spouses,” when prosecuting immigration cases, said spokesman Devin O’Malley, so there’s no way to know how many military family members were among those persons removed last year. [Source: MiliraeyTimes | Tara Copp | April 1, 2018 ++]

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Battle of Okinawa Update 01 ► Easter Sunday | A Time to Remember

As we celebrated Easter Sunday and the Jewish Passover, it was also the time to keep in our prayers and remembrances the many Americans who fought and sacrificed during that same time 73 years ago in the Battle of Okinawa. The event was Operation Iceberg. It was the bloodiest battle and the largest amphibious assault in the Pacific Theater of World War II. On Easter Sunday, April 1, 1945, the Navy’s Fifth Fleet under Adm. Raymond Spruance attacked the Japanese-held island. They were joined by a British, Canadian, New Zealand, and Australian naval task force and more than 180,000 Army soldiers and Marines. This was the final push toward invading mainland Japan and putting an end to the war.

Military planners considered the capture of Okinawa and its airfields to be a crucial and necessary precondition for the invasion of the Japanese mainland. Were the U.S. to invade Japan, estimates of potential American casualties were upward of 1.7 to 4 million, with between 400,000 and 800,000 deaths. The Battle of Okinawa only served to raise those estimates, as had the recent brutal battle for Iwo Jima, where U.S. casualties numbered 26,000 over five weeks of fighting. Only a few hundred Japanese had been captured out of the 21,000 troops who fought to the death. Those expected casualties were the major reason for President Harry Truman’s decision to use the atomic bomb.

The Japanese military knew that Okinawa was its last stand in the Pacific. As a result, it fixed 77,000 troops on the island under the command of Lt. Gen. Mitsuru Ushijima, along with a 20,000-strong Okinawan militia. The Japanese forces even included 1,800 middle school boys conscripted into the “Blood and Iron Corps.” The American invasion started with a massive seven-day naval bombardment of the landing beaches, where heavy resistance from the Japanese forces was expected. That prelanding bombardment included tens of thousands of artillery shells, rockets, mortar shells, and napalm attacks.

The Japanese allowed American troops to land unopposed on Easter Sunday and to move inland with nominal resistance. Japanese troops had been ordered not to fire on the American landing because Ushijima wanted to lure

the American forces into a trap he had laid for them in what became known as the Naha-Shuri-Yonabaru Defense Line in southern Okinawa, a rugged terrain riddled with fortified pillboxes, gun emplacements, tunnels, and caves. The Japanese also sent the battleship Yamato on a one-way suicide mission to Okinawa, but it was spotted by Allied submarines and sunk (along with a cruiser and four enemy destroyers) by American pilots, downing nearly the entire crew of over 2,300.

The far more dangerous attacks on the Allied fleet were by dense waves of suicide kamikazes diving their planes into ships. The Fifth Fleet lost 36 ships in the Battle of Okinawa and suffered damage to another 368 ships. Almost 5,000 U.S. sailors and pilots were killed and almost as many were wounded, with over 700 Allied planes being shot down. It was the biggest naval loss of the war. On Okinawa, Americans fought ferocious battles on almost every defended hilltop. Torrential rains turned the island into a sea of mud that bogged down tanks, trucks, and other heavy equipment. The most infamous hilltop was Hacksaw Ridge, a 400-foot cliff on the Maeda Escarpment that was depicted in a 2016 movie about Cpl. Desmond T. Doss. Doss was a Seventh-Day Adventist and conscientious objector who became a combat medic. He was awarded the Medal of Honor for rescuing 75 wounded soldiers at Hacksaw Ridge.

In almost every fight on Okinawa, American troops fought for every foot of ground in hand-to-hand combat against fanatical Japanese troops who often took their own lives rather than surrendering. That eventually included Ushijima and his chief of staff who committed seppuku on June 22. It was Ushijima who had ordered his troops to “fight to the death.” With his suicide, the Battle of Okinawa was effectively over. The Battle of Okinawa was the deadliest fight of the Pacific island campaign. The Japanese knew they could not win. Their purpose was simply to make the battle as costly as possible to the Americans and to hold them off as long as possible, allowing Japan to prepare for the defense of their home islands. Thus, Japanese commanders considered all their forces and the residents of Okinawa totally expendable.

Americans incurred almost 50,000 casualties on Okinawa, including over 12,000 dead. Those killed included the American commander, Lt. Gen. Simon Bolivar Buckner, who was killed by enemy artillery fire just four days before the battle ended, making him the highest-ranking U.S. officer killed during the entire war. Ernie Pyle, the famous war correspondent, was also killed when he was shot by a sniper on a small island northwest of Okinawa. In addition to Doss, six other Americans who fought in the battle received the Medal of Honor, our nation’s highest award for bravery under fire.

But the Japanese losses were much greater. Only 7,400 Japanese soldiers survived—90 percent of Japanese troops on the island fought to the death. Almost 150,000 Okinawan civilians were killed, amounting to one-third of the prewar population. Many were used as human shields by Japanese troops. Others threw themselves and their families off cliffs on the southern part of Okinawa in mass suicides after the Japanese convinced them that the Americans would kill or rape anyone they captured. Ironically enough, it was Japanese troops who engaged in mass rapes of Okinawan women during the battle.

The bloody, ferocious battle for Okinawa lasted 82 days and left the island a “vast field of mud, lead, decay, and maggots” according to Ted Tsukiyama’s “Battle of Okinawa.” Almost every building on the island was destroyed. Truman’s decision to bomb Hiroshima and Nagasaki in August ended the war and all Japanese resistance, thereby preventing the enormous American casualties that would have resulted from a land invasion of Japan. On Easter

Sunday, American Christians celebrate the resurrection of Jesus Christ, which marks the triumph of good over evil, sin, and death. At the same time during Passover, Jewish Americans celebrate their liberation from slavery in ancient Egypt. Those celebrations are profound and deeply significant. But every April 1st we should also pause to remember the Americans and their allies who, 73 years ago, fought and died during Easter and Passover to preserve our freedom and end a brutal war started by a ruthless military dictatorship intent on enslaving the people it conquered. We and the world owe them more than we can ever repay. [Source: The Daily Signal | Hans von Spakovsky | March 30, 2018 ++]

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WWII Vets 161 ► Richard Overton | Will Turn 112 Next Month

Richard Overton, the grandson of a slave, worked in a furniture store and as a courier for decades until he finally retired when he was 85. That was more than 25 years ago. Now, Overton — the country's oldest living World War II veteran — has been enjoying a bit of fame for his longevity, and has a regular stream of visitors to his home in Austin, Texas. Last week, he mentioned to one of his visitors that he'd like to someday see the National Museum of African American History in Washington, D.C. The following morning, Overton and a few friends were on a private jet heading toward the nation's capital. They got a private tour of the museum before it opened to the public Sunday morning.

It was one in a line of stunning and unlikely happenings for Overton, who is believed to be the oldest living American and the third-oldest person in the world. His 112th birthday is next month. His secret to a long life includes cigars, whiskey and speaking his mind. "I enjoyed every bit of the tour," Overton said at the museum as he was lunching on soul food. Then he added, "I didn't see my name up there," referring to the World War II exhibit. His friends chuckled. "One of these days it will be," he assured them.

The whirlwind tour was put in motion after one of Overton's friends, Allen Bergeron, introduced him to billionaire philanthropist Robert Smith, who donated $20 million to the museum. Bergeron knows both men through his work with the Austin Military Veterans Program. Bergeron said he has been trying to introduce the two men for years; Smith's father and grandfather served in the military, and Overton served as a sharpshooter in Pearl Harbor and Okinawa. On Friday (6 APR), he was finally able to bring Smith to Overton's house for a visit. The two men talked for two hours and ate fried catfish. That was when Overton said he'd like to see the museum. Smith replied, "What are you all doing this weekend?" according to Bergeron. It was settled.

While they were on the tour, retired four-star general and former Secretary of State Colin Powell, who is on the museum board, called Overton to welcome him. The two had never met. "Everything we do with Mr. Overton turns magical," Bergeron said, adding that a street in Austin was recently named after Overton. Overton has been to the White House several times and met President Barack Obama. When he came across the museum exhibit featuring the former president, he sat up a little taller in his wheelchair. "Yes, sir!" he said. "That's my friend." Asked if he had been nervous to meet Obama, he shook his head. "He's a good man," Overton said. "It was like meeting anybody."

A few years later, when Overton turned 109, he was still tending his own lawn and driving his own car. He celebrated that birthday with cigars, milkshakes, burgers and a big party. Although life after 100 has been exciting for Overton, there have also been frustrations, said his cousin Volma Overton, who oversees his care. "His mind is strong, but his body is frail," he said. Volma Overton said he wants to keep Richard Overton in his house where he's happy and comfortable. People stop by every day to see him, many of them strangers who have read about him in the news, he said. "His front porch is his everything," said Volma Overton, 70, who works as a greens keeper on a golf course. "It's his throne."

Richard Overton's veteran's benefits would pay to move him to an assisted-living facility, but Volma Overton said that would "kill him." Volma Overton began round-the-clock care at his cousin's home a year and a half ago, but at $15,000 a month, he couldn't afford to maintain it. He started a GoFundMe page, which raised more than $200,000, but that money has been spent on in-home care, leaving the family in debt. Richard Overton does not have children. He married twice; he and his first wife divorced in the 1920s, and his second wife died in the 1980s. "He's outlived almost everybody in his family," Volma Overton said.

He was born March 11, 1906, in Texas, and served in the Pacific Theater from 1942 to 1945 as part of the all-black 1887th Engineer Aviation Battalion. He grew up hearing his grandfather's stories of being a slave in Tennessee. When his grandfather was freed, he moved to Texas, where his family settled. On Sunday, Richard Overton said it was meaningful for him to see the museum and the African American story through time: from his grandfather's history as a slave to his own history as an African American fighter in World War II and then the pride of the first African American president. "All of it is important," he said. "I'd seen some of it before, but I've never seen it all at once." [Source: The Washington Post | Allison Klein | April 9, 2018 ++]

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TRICARE Enrollment Update 02 ► Active Duty Retirement

Retiring from active duty, whether a medical retirement or a regular retirement, is a significant  life event. You should know before you retire which TRICARE programs best suit your and your family’s needs. Once you retire, you’ll only have 90 days from your retirement date to enroll in a TRICARE plan to continue TRICARE coverage. Otherwise, you will have no TRICARE Purchased Care coverage and will only be able to access care at military hospitals and clinics on a space-available basis.  The TRICARE Health Program is often referred to as purchased care. It is the services we “purchase” through the managed care support contracts. If you retire from active duty and are under age 65, you can choose either TRICARE Prime (where available) or TRICARE Select (available worldwide). You should decide before you retire which one best suits your and your family’s needs.

You may reenroll in TRICARE Prime if you live in a Prime Service Area (PSA) or live within 100 miles of an available primary care manager and waive your drive-time access standards. You can see if you live in a PSA by using the TRICARE Plan Finder. If you choose not to reenroll in TRICARE Prime or don’t live in a PSA, then you may enroll in TRICARE Select With TRICARE Select, you can see any TRICARE-authorized provider you choose, but you save money when you use TRICARE network providers. Referrals are not required for most health care services, but some services require prior authorization from your TRICARE regional contractor. If you live overseas, you may seek coverage under TRICARE Overseas Program (TOP) Select. TOP Prime and TOP Prime Remote options are not available after retirement.

If you or a family member are, or become, entitled to premium-free Medicare Part A after your retirement, you or they will lose TRICARE coverage unless enrolled in Medicare Part B. With Medicare parts A and B, you or they will have coverage under TRICARE For Life. For more information on how to enroll in a TRICARE plan, visit Enroll or Purchase a Plan on the TRICARE website. Learn more about TRICARE plans during retirement in the Retiring from Active Duty Brochure. [Source: Health.mil | April 3, 2018 ++]

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Chronic Chillness ► Causative Conditions

Certain medical conditions can cause your hands and feet to always feel chilled. As anyone who has worked in a shared office space can tell you, people have different body temperatures. Some people freezing while others roast is quite common, but if you constantly feel chilly when others seem comfortable, there may be a medical issue at play. The numerous potential causes for coldness include hypothyroidism, calorie reduction and general aging, where

people become more sensitive to cold temps due to a decrease in the metabolic rate and thinning of fat under the skin. A few other causes that affect older people frequently should probably be addressed with a doctor.

AnemiaAre your hands and feet always freezing? Anemia, a condition in which you don't have enough healthy red blood cells to carry adequate oxygen to the body's tissues, may be the culprit. The condition is commonly overlooked in older people, according to a 2010 study published in American Family Physician, with more than 10 percent of people over 65 being anemic and the prevalence increasing with age. Anemia also may make you feel tired and weak, according to the Mayo Clinic. Other symptoms include pale or yellowish skin, irregular heartbeat, shortness of breath, and headaches. Some types of anemia can be treated through better nutrition, although it is always important to discuss potential options with your doctor. Lack of vitamin B12 and iron deficiency can cause anemia and lead you to feel cold. Good sources of B12 are chicken, eggs and fish, and people with iron deficiency may want to seek out poultry, pork, fish, peas, soybeans, chickpeas and dark green leafy vegetables.

Type 2 DiabetesDiabetes can cause anemia, kidney and circulation problems, which can lead people to feel cold. It can also lead to nerve damage and peripheral neuropathy, which affects an estimated 20 million people in the United States, according to the National Institute of Neurological Disorders and Stroke (NINDS), and results from damage to the peripheral nervous system. A warning sign for this could be if your feet feel cold but aren't cold to the touch. Keeping diabetes in check is a good way to prevent peripheral neuropathy, and you should talk to your doctor about other possible treatments. "When this develops, you experience numbness and sometimes pain in the hands and feet, and since these nerves are also responsible for sending messages to the brain regarding temperature sensation, your hands and feet may feel cold,” Margarita Rohr, an internist at NYU Langone medical center in New York, told Health.com. Other symptoms of diabetes include frequent urination, fatigue and increased thirst.

Kidney DiseaseDiabetes and high blood pressure often lead to kidney disease, which means that your kidneys don't work as they should to filter your blood. Waste can build up to dangerous levels, which can cause lower core body temperature. Kidney disease is also linked to anemia, and your risk increases with age, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The longer you have diabetes, high blood pressure or heart disease, the greater your risk of developing kidney disease.

Peripheral Artery DiseasePeripheral artery disease (PAD) is a common circulatory problem in which your arteries become narrowed, which reduces blood flow to your limbs, according to the Mayo Clinic. PAD prevents your extremities, typically your legs, from receiving adequate blood flow to keep up with demand. Coldness in a lower leg or foot, especially when compared with the other side, can be a sign of this condition. In addition to cold, you may feel leg pain when walking. PAD could also reduce blood flow to your heart and brain, so it is important to address it with your doctor, especially if you are over 70, or over 50 and have a history of diabetes or smoking.

Medication ComplicationsSome drugs may make you feel colder as a side effect, including beta-blockers used for heart disease, according to the Cleveland Clinic. These blockers help the heart relax but also may cause you to feel dizzy, tired, nauseous, and colder in your hands and feet. Calcium channel blockers can also be a culprit. Your doctor may be able to lower your dose or find an alternative medication.

[Source: AARP | Kim Hayes | February 23, 2018 ++]

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VA Medical Marijuana Update 43 ► Shift In Federal Policy Called For

Former House Speaker John Boehner on 11 APR said he has shifted his stance on medical marijuana in part because of the potential positive effects it could have for suffering veterans. Boehner, who said he was opposed to medical marijuana legalization during his time in office, this week was appointed to the board of advisers for Acreage Holdings, one of the country’s largest cannabis cultivation and dispensing firms. In a statement, he called for “a shift in federal marijuana policy” and said his views on the issue have “evolved” in recent years. “We need to look no further than our nation’s 20 million veterans, 20 percent of whom, according to a 2017 American Legion survey, reportedly use cannabis to self-treat post-traumatic stress disorder, chronic pain and other ailments,” he said in a statement released by Acreage Holdings.

“Yet the [Department of Veterans Affairs] does not allow its doctors to recommend its usage. There are numerous other patient groups in America whose quality of life has been dramatically improved by the state-sanctioned use of medical cannabis.” Boehner said one of the main obstacles to further marijuana research and acceptance is the federal classification of cannabis as a Schedule 1 drug, which places strict testing and procurement guidelines on medical testing of the drug. The former speaker’s support now makes him the most prominent Republican in the country to actively advocate for a change in marijuana laws.

The move comes as veterans groups have made a major push on Capitol Hill for expanded marijuana research, arguing that it has the potential to become a safer alternative to highly addictive opioids for tens of thousands of veterans nationwide. The American Legion’s survey, released in November, found that more than 90 percent of veterans support expanding research into medical marijuana, and over 80 percent back allowing federal doctors to prescribe it to veterans. Medical marijuana is legal in 29 states and the District of Columbia, but is still illegal to use or possess under federal law. That prevents VA doctors from prescribing it to patients even in states where it is available.

Last year, VA officials updated their guidelines to allow doctors to discuss medical marijuana with patients in an effort to better gauge its usage among veterans. But administration officials still will not let physicians recommend its use or provide assistance in obtaining the drug. Boehner said he hopes his work at Acreage will help “transform the debate, policy and landscape around this issue.” Legislative efforts to reschedule cannabis and legalize medical marijuana nationwide have stalled in Congress in recent months. [Source: MilitaryTimes | Leo Shane III | April 11, 2018 ++]

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Deep Vein Thrombosis Update 01 ► What You Need To Know

Military Health System beneficiary Jamia Bailey plays three sports at Yokota High School in Fussa, Japan. She spends long hours traveling with her teammates to competitions at schools eight and even 10 hours away. When her left leg became swollen and painful one morning during class, a trip to the school nurse’s office and then to the urgent care clinic on Yokota Air Base schooled Bailey on deep vein thrombosis (DVT). This is a blood clot that forms in a vein deep inside the body. It usually occurs in the lower leg, thigh, or pelvis. “Blood clots naturally form in our body after injury to prevent blood loss through the blood vessel wall,” said Air Force Col. Jay Sampson, a board-certified vascular surgeon at Lackland Air Force Base in San Antonio. “We also have a natural process to stop clot formation and then to break down the clot,” he said. “DVT occurs when something goes wrong with this clotting process.”

As many as 900,000 Americans may be affected by DVT each year, according to the Centers for Disease Control and Prevention. Of those, the CDC said, about half will have long-term complications, including swelling and pain. Additionally, about 33 percent will have a DVT recurrence within 10 years. DVT is particularly dangerous if part of the clot breaks off and travels through the bloodstream to the lungs. This causes a pulmonary embolism, or PE, which prevents blood from reaching the lungs. According to the CDC, from 60,000 to 100,000 people die each year

from PE. “Numerous risk factors can help identify who might be at risk for DVT,” Sampson said. “But in the medical community, we tend to think of it as, everyone’s at risk.”

Risk factors include being obese, older, or confined to bed because of illness or disease, Sampson said. But even young and fit people can be at risk when they’re immobile for long periods of time. NBC television journalist David Bloom was 39 when he died of PE in April 2003 while covering the Iraq War. Bloom had spent long hours inside cramped armored vehicles. Pregnant women up to six weeks after childbirth, and women who take oral contraceptives that include estrogen, also have an increased risk of DVT, Sampson said. Changes in hormone levels and blood composition may affect the normal clotting process. Also, blood flow in the legs may be reduced because of the fetus pressing on the veins. Swelling and pain are two symptoms of DVT. But some people don’t experience any symptoms at all, Sampson said. The signs and symptoms of PE include difficulty breathing, chest pain, and coughing up blood. But sudden death, like Bloom’s, is the first symptom in about 25 percent of people with PE, according to the CDC.

Bailey went to Tripler Army Medical Center in Hawaii for treatment with dad James, a retired Navy senior chief petty officer, and mom Pia, a Department of Defense Education Activity elementary school teacher. “Jamia was predisposed to getting DVT because she has May-Thurner syndrome, and the long periods of immobility during bus rides were a contributing factor,” said Dr. Brian Ching, an interventional radiologist at Tripler. May-Thurner is a rare condition in which an artery compresses a vein in the pelvis. Bailey had minor surgery to remove the blood clots; a stent was inserted into the compressed vein to keep it open. She’s now taking a blood thinner to reduce the risk of DVT recurring. “A blood thinner prevents the clot from getting bigger,” Sampson said. “It also stabilizes the clot to reduce the risk of it traveling to the pulmonary artery. That’s the pulmonary embolism we worry about.”

Bailey said she can’t play soccer while she’s taking a blood thinner because any head trauma could cause bleeding in the brain. Otherwise, she’s resumed her normal activities. Her goal is to play basketball next year for Chaminade University in Hawaii. “I really appreciate the doctors and nurses who helped me get through that rough part of my life,” she said. Sampson and other experts offer the following tips to reduce risk of DVT:

Move around as soon as recommended after being confined to bed for surgery, illness, or injury. Stretch your legs every few hours during long periods of immobility, including during air travel. Wear

loose-fitting clothing and perhaps even compression socks, which prevent pooling of blood in the legs. Seek medical help immediately for swelling and pain in the legs or arms. “The next step would be an

ultrasound test to diagnose,” Sampson said.

[Source: Health.mil | April 9, 2018 ++]

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Opioid Use Update 01 ► VA Overdose-Reversal Naloxone Kits

In 2016, more than 46 people died every day from overdoses involving prescription opioids. Today, 40 percent of all U.S. opioid overdose deaths involve a prescription opioid. Throughout April, VA Women’s Health Services (WHS) is bringing awareness to opioid risks, promoting best practices for the safe use of opioids, and providing education for overdose-reversal Naloxone Kits, informing women Veterans how to respond to an opioid overdose in the event of an emergency. WHS is sharing these important messages about overdose prevention and practicing safe use:

Don’t Mix. Do not mix opioids with alcohol, Benzodiazepines sometimes called “benzos” (Xanax, Ativan, Valium), or any medication that causes drowsiness. Know the color, shape, size, and name of your prescription opioid. Talk to your provider about co-prescription safety.

Don’t Share. An opioid dose prescribed to you could cause an overdose if shared with another person. Do not share your medication with anyone else.

Take as Directed. Take opioid medication exactly as directed. Taking too much of your opioid medication can cause you to pass out or stop breathing, resulting in brain damage or even death.

Consult your Provider. If you stop taking your prescription opioid, even for a few days, taking the dose that you consume regularly could cause an overdose. Check in with your VA provider throughout the duration of your opioid use to ensure you are practicing safe use.

Remove old medications. Removing expired or unwanted prescriptions and over-the-counter drugs reduces the risk of taking the wrong drug by mistake, the chance of accidental poisoning, especially in children, and/or misuse by family and friends. You can prevent opioid misuse by safely disposing of these medications as soon as you no longer need them. Check with your VA Pharmacist about how VA can help you safely

dispose of unwanted prescriptions. Irritable Bowel Syndrome ► Three Ways You Can Keep Your Gut Happy and Healthy

IBS (Irritable Bowel Syndrome) affects 1 in 5 people in America. It is a disorder that can cause various gastrointestinal (GI) symptoms such as diarrhea, constipation, bloating and abdominal pain. If your doctor has talked to you about a possible Irritable Bowel Syndrome diagnosis, there is hope. Nutrition and lifestyle changes can help manage your symptoms. Here are three ways you can keep your gut happy and healthy:

Try a lactose-free diet

Lactose is the natural sugar found in milk. About 65 percent of the world population is lactose-intolerant. This means that their bodies do not produce enough enzymes to break down milk sugar, which can cause and worsen GI symptoms. If you try a lactose-free diet, eliminate all foods that contain lactose. This includes dairy foods like cow’s milk, ice cream, certain cheeses, cottage cheese and yogurt. Lactose-free milk is a good replacement, and is found in most grocery stores. Some foods contain less lactose than others, and may be better tolerated. Examples include hard cheeses such as cheddar and parmesan. Eliminate high lactose foods for at least a week to see if your GI symptoms improve. Check out this page for more tips and information about dairy. Your VA dietitian can help you implement a lactose-free diet and ensure you are meeting your nutrient needs that dairy products provide (such as calcium and vitamin D).

Reduce stress

Stress plays a significant role in worsening symptoms. Since your brain and gut are linked through many hormones and nerve connections, lowering your stress may reduce your GI symptoms. For effectively lowering your stress, try deep breathing exercises, meditation or journaling. There are many free stress management resources online, like this from the American Heart Association. Include at least one stress-reducing activity per day. Many VA facilities offer stress management resources, such as group classes or individual instruction. Check with your local VA facility for options.

Consider a low-FODMAP diet

The FODMAP diet is an elimination diet that removes fermentable oligo-, di-, and mono-saccharides, and polyols which are types of carbohydrates and sugar alcohols that can worsen symptoms. High FODMAP foods can be poorly digested in people Irritable Bowel Syndrome, and can cause excess gas, bloating and other GI symptoms. By

trialing an elimination of high FODMAP foods, many find that their symptoms are significantly reduced. Common high FODMAP foods include onions, garlic, cow’s milk and wheat. To learn about other high FODMAP foods check out this page from the National Institute of Health. Consider starting a journal to track food and beverage intake and any GI symptoms that occur, including severity. Because there are many foods to consider, a low-FODMAP diet can be difficult to manage on your own. For the best results, work with your local VA dietitian to help you navigate this process, and help you find symptom relief.

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Although there is no known cure for Irritable Bowel Syndrome, it can often be successfully managed with changes to diet and lifestyle. In addition to the diet considerations listed above, limiting excessive fat intake may also help improve symptoms. If you’re interested in learning more about how to eat with an Irritable Bowel Syndrome diagnosis, or any other nutrition-related topic, contact your local VA to speak with a registered dietitian.

[Source: VAntage Point | Maria Zamarripa | April 3, 2018 ++]

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Reverse an overdose with Naloxone. A prescription opioid overdose can be fatal and requires immediate

emergency attention. Knowing the signs of an opioid overdose and how to use a Naloxone Kit can help save a life.

A prescription opioid overdose can be fatal and requires immediate emergency attention. Knowing the signs of an opioid overdose and how to use a Naloxone Kit can help save a life. Go to https://youtu.be/0w-us7fQE3s for a vidoe on how to use it. Indicators that someone has overdosed and the kit should be used are:

o Extremely pale in the face and/or feels clammy to the toucho Confusion, delirium, or acting drunko Extreme sleepiness, or the inability to wake upo Frequent vomitingo Loss of consciousnesso Slowed or irregular breathing

Naloxone is a prescription medication that is a highly effective treatment for reversing an opioid overdose in the event of an emergency, if administered in a timely manner.  The most common Naloxone Kit includes an easy-to-use nasal spray with instructions. Other kits contain injections. Both forms are effective in reversing a life-threatening opioid overdose when used as intended. VA’s Opioid Overdose Education and Naloxone Distribution (OEND) Program provides Naloxone Kits to at risk Veterans. VA’s OEND program trains patients on proper naloxone administration technique and how to prevent, recognize, and respond to an opioid overdose. If you are prescribed opioids, ask your VA provider if a Naloxone Kit is right for you. For additional information and VA online resources refer to http://bit.ly/2CmIi5m. [Source: VAntage Point | April 10, 2018 ++]

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Direct Deposit Update 04 ► Address Changes For Government Payments

If you are getting government payments you are most likely receiving them via Direct Deposit. In fact, the government requires all payments to individuals be made via direct deposit, there are exceptions to this rule, but they can be cumbersome. If you are unable to obtain a bank account, the government will issue you a debit card, they will then deposit your payments to that debit card. For more information see the DFAS website. If you are one of the 99 percent of the people who get your government payments by direct deposit or Electronic Funds Transfer (EFT), the following addresses just how to change your bank account information in case you move or change banks.

Direct Deposit of VA Payments

If you get payments from the VA for GI Bill, disability compensation, vocational rehabilitation, Dependents Indemnity Compensation, or more you can change your direct deposit information on the VA's eBenefits website. To change your information click on "Manage" on the top of the screen, then click on "Contact and Direct Deposit" on the menu that appears. To update your payment information online, you must have a submitted claim that is currently under consideration or be receiving benefits. You can also mail the Direct Deposit Enrollment VA's eBenefits website. to: VA National Direct Deposit Center, Suite B, 125 S. Main Street, Muskogee, OK 74401. If you have problems, the best way to get a speedy answer is calling the VA. For GI Bill benefits, call 888-GI BILL (888-442-4551), for all other benefits call 800-827-1000.

Military Retirement & Survivor Benefit Plan Payments

If you are receiving military retirement or Survivor Benefit Plan (SBP) annuity payments, the fastest and easiest way to change your direct deposit account information is through the Defense Finance and Accounting System (DFAS) myPay online account access system. If you don't already have a myPay account, it can take a little effort to set one up, but the benefit is worth the effort. You'll have 24 hour a day, 7 day a week access to your account details, annual account statements, the ability to change your direct deposit account, change your mailing address, and print tax statements.

If you are unable to set up a myPay account, or do not want to, then you will need to change your direct deposit information using the paper Direct Deposit Enrollment Form (FMS 2231), and mailing it to: Defense Finance and Accounting Service, 8899 E. 56 Street. Indianapolis, IN 46249. Paper forms may take up to 60 days to be processed. As always, if you have problems, you can always call DFAS at 800-321-1080 for help.

Direct Deposit Overseas

If you are living overseas and want your government payments directly deposited into an American bank, you follow the instructions above, if you want them deposited into a foreign bank it can be a bit trickier. Normally, the deposit will be in U.S. Dollars, the bank will convert it to the local currency, you may have to pay a conversion fee. If you are in Canada you have the option to be paid in U.S. Dollars or Canadian Dollars. Currently the U.S. Treasury allows your VA payments to be directly deposited into foreign banks in 65 different countries, and your military retirement to be directly deposited into foreign banks in 45 countries. To sign up for direct deposit into a foreign bank you will need to submit an International Direct Deposit Enrollment SF 1199-I) and submit it by mail to the proper agency above.

[Source: Military.com | Jim Absher | April 11, 2018 ++]

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SBP Premium Update 02 ► Deductions From CRSC Started 1 APR

Did you see the Defense Finance and Accounting Service (DFAS) notification that Survivor Benefit Plan (SBP) premiums are now deducted from Combat-Related Special Compensation (CRSC) payments? Written into the 2017 National Defense Authorization Act and first announced by DFAS last fall, this change notification was released again this year because the first deductions were about to start 1 APR. This deduction will not result in any loss of total compensation for combat-injured veterans. What it will do, is “clean-up” what I would call an accounting issue.

How did this “accounting issue” come about? For some retirees, the “VA Waiver” (see note below) subsumes some or all of their retired pay — such that there isn’t enough left for DFAS to deduct SBP premiums. In this case, DFAS works with the VA to have SBP premiums deducted from the veteran’s VA tax-free disability compensation. This way there is no tax implication for the veteran; this upcoming change will not impact veterans. Their SBP premiums will still be deducted by the VA and sent to DFAS to cover SBP premiums.

Note: when total VA disability rating is 40% or less, or if in receipt of CRSC, the “VA Waiver” is the dollar amount equal to VA disability compensation that is deducted from military retirement pay.

However, retirees receiving CRSC, whose “VA waiver” was subsuming retirement pay, had to remit SBP premiums (meaning they wrote a check) directly to DFAS. Some of these veterans didn’t always remember to send their SBP premium payments to DFAS, putting them in a debt status. To “clean-up” the possibility of debt, DFAS was ordered to institute a fix. Since these retirees don’t have enough funds to pay their SBP premiums from pre-tax retirement pay but receive tax-free CRSC, the fix is to deduct SBP premiums from tax-free CRSC payments. This new accounting action not only prevents a possible debt, but also eliminates additional paperwork for both DFAS and the veteran. These retirees will have a smaller CRSC check, but they won’t have to write a check for their SBP premiums from post-tax funds. It also prevents the possibility of severely disabled veterans falling behind on their SBP premiums, and potentially leaving the surviving spouse with a liability when the veteran passes. Deductions from CRSC payments to cover SBP premiums began April 1, covering the month of March 2018. [Source: MOAA Newsletter | Paul Frost | April 12, 2018 ++]

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Annuities ► What They Are

An annuity is essentially an investment issued by an insurance company. There are three different kinds:

An immediate annuity A deferred annuity A variable annuity

When you buy an immediate annuity, you give the insurance company a lump sum, and they give you monthly payments. There are lots of options for how you receive the payments. For example, the payments could extend over five years, 20 years, the rest of your life, or for your life and then your spouse’s life. A deferred annuity, on the other hand, is like a bank CD, except it’s from an insurance company. You give them your money, they pay interest on it, then give it back at some future date. The final type of annuity, a variable annuity, is like a mutual fund — except that instead of investing through a mutual fund company, it’s sponsored by an insurance company. As with mutual funds, within the variable annuity, you’re typically investing in stocks, bonds, or a combination of both.

Why do people want to invest through an insurance company? Why not just get a CD from a bank, or a mutual fund from a mutual fund company? The reason is that insurance companies bring a couple of advantages to the table. Investments with an insurance company “wrapper” allow earnings to grow tax-deferred, meaning you don’t pay taxes on earnings until you receive them. Another advantage offered by insurance companies is the ability to bypass probate. So, as with an IRA or 401(k), you name a beneficiary when you set it up. If you should die, the money goes directly to that beneficiary, bypassing probate. These are a couple of reasons why people use insurance company products, versus regular products from banks or brokerage firms.

When you’re shopping for an annuity, no matter what kind it is, be aware of fees. Annuities often have monster fees, and they’re not always clear. For that reason, avoid buying annuities from commissioned salespeople if you can help it. If you need professional advice, get it. But try to get it from someone who charges by the hour, instead of somebody who gets commissions. As with mutual funds, some companies selling insurance products have lower fees than others. Insurance products from TIAA-CREF, USAA and Vanguard have historically included lower fees.

Another thing to know: Interest rates are now starting to rise. If you’re thinking about a deferred annuity, or an immediate annuity, be aware that the higher the interest rate is when you lock it in, the more money you’re going to make. So, the worst time to buy an annuity is when interest rates are really, really low. And the best time to buy an annuity — whether it’s immediate or deferred — is when interest rates are high.

Also, be aware that annuities typically have long surrender penalties. When you put money in, it’s going to be locked up, often for 10 years or more. So, you want to get the best deal you can. Since I’m seeing interest rates rising, I’m waiting before I lock my money into any kind of annuity. [Source: MoneyTalksNews | Stacy Johnson | April 4, 2018 ++]

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IRS 2018 Filing Season Update 01 ► Tax Cuts | Who Benefits

Individuals across every state and income level will see their next federal income tax bill drop, on average, according to a recent report from the Tax Policy Center. “On average” is the key phrase here, though. Drops can vary widely from one state to another and one income group to another. And not everyone will see a decrease in their 2018 tax bill, the one that’s due in April 2019. The Tax Policy Center analyzed how the Tax Cuts and Jobs Act, which became law in December 2017, impacts individual income taxes. The analysis does not account for changes to corporate tax rates, excise taxes, gift taxes or estate taxes. Here’s what it shows:

States Which will benefit more -- Nationwide, folks will see their after-tax income rise by about an average of 1.8 percent in tax year 2018 due to the tax code overhaul, according to the Tax Policy Center. In seven lucky states, however, the rise in after-tax income will exceed 2.1 percent. These states are: Alaska, Louisiana, North Dakota, South Dakota, Texas, Washington, and Wyoming

States Which will benefit less-- At the other end of the spectrum are three states in which the rise in after-tax incomes will be less than 1.5 percent. They are: California, New York, and Oregon

The wealthiest benefit more -- The Tax Policy Center estimates that the tax code overhaul will cut taxes for about 65 percent of households overall, with decreases averaging about $2,200. However, the center found that the wealthier you are, the more likely you are to see your taxes drop — and the bigger the decrease stands to be. For example, the overhaul will cut taxes for an estimated 90 percent of households in the top quintile — that’s the top 20 percent of income earners. Their taxes will decrease by an average of $7,170. But for 27 percent of households in the bottom quintile, it will cut taxes with decreases of an average $190. In the middle quintile — the middle class — about 82 percent of folks will see a tax cut, with decreases averaging $1,050.

To learn more about how the Tax Cuts and Jobs Act will impact your bottom line in tax year 2018, check out 3 Big Ways the Tax Overhaul Will Affect Your 2018 Tax Return.” [Source: MoneyTalksNews | Karla Bowsher | April 5, 2018 ++]

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Lending Money Update 01 ► Family | Lender Tax Ramifications

Beyond the family dynamics involved when you partake in business transactions with a person to whom you are related, there are tax ramifications. Imagine Junior is on his own now, and you want to help him. You loan him $50,000 for a down payment on a house. In the eyes of the IRS, you've just entered into a business relationship with Junior. Because you don't need to make money on the loan, you don't charge Junior any interest. What parent would charge their child interest on a loan if they didn't need the money?  Well, the IRS says every parent would charge interest.

In fact, the IRS sets a minimum interest rate a lender is assumed to charge. It is called the Applicable Federal Rate (AFR). The IRS will not allow you to charge less than this amount of interest on a loan to anyone other than your spouse. What happens if you don't charge the AFR-required rate? The IRS will impute interest. What this means, in essence, is the IRS will say you received interest income based on the AFR, and you will owe taxes on that income. The IRS also will say the instant you received that income, you gave it back to Junior. In other words, you'll pay taxes on income you didn't actually receive. There are exceptions, and the most notable is that imputed interest rules do not apply to loans of less than $10,000 - as long as the loan is not used to buy income-producing assets.

Let's examine another possible business deal among family members. You decide to sell Junior your beach house. It doesn't qualify as your primary residence, so there will be income tax due on the sale - a lot of income tax.You've heard about a technique called an installment sale, and you decide you will sell the house to Junior that way. In an installment sale, Junior pays you back over time, and you only pay taxes on the prorated capital gains each year. Great deal, right?  It should be, but it might not be. If Junior sells the property prior to owning it for two years, you must report and pay taxes on the entire remaining capital gains on the property the year of the sale. That is true regardless of when Junior pays you back.

The IRS publishes three AFRs: short-term, mid-term and long-term. Short-term AFR rates are determined from the one-month average of the market yields from marketable obligations, such as U.S. government T-bills with maturities of three years or less. Mid-term AFR rates are from obligations of maturities of more than three and up to nine years. Long-term AFR rates are from bonds with maturities of more than nine years. In July 2016, for example, the annual short-term AFR was 0.71%, the mid-term AFR was 1.43% was and the long-term AFR was 2.18%. [Source: The MOAA Newsletter March 15, 2018 ++]

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Revocable Living Trust ► What It Is and Does

A trust is a legal relationship under which a person (the grantor or settler) transfers assets to a named trust. As long as the grantor remains alive, assets transferred into the trust remain the property of the grantor. Income generated by trust assets are included as part of the grantor’s annual income tax return. At the death of the grantor, asset management and asset distribution become responsibilities of the standby trustee named in the trust document. The trustee is responsible for seeing that all terms of the trust are fulfilled. Advantages of having a Revocable Living Trust are:

You have complete control of your assets while you are alive. You avoid the expense of probate. Estate administration costs are reduced. Reduces delays in distribution of assets to your beneficiaries.

[Source: https://en.wikipedia.org/wiki/Trust_law | April 2018 ++]

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Revocable Living Trust Update 01 ► Benefits of Establishing One

Following is an excellent estate planning article written by Col. Steve Strobridge, USAF (Ret), former co-chair of The Military Coalition, which could benefit many in the military retirement community. Something to consider before you pass on.

During their working lives, too many people fail to think about estate planning. Shocking numbers haven’t even prepared a will. By the time you approach retirement age, you probably accomplished this. But is a will enough? Unfortunately, many in their 40s, 50s, and 60s have estate-planning issues thrust upon them because of the death

of their parents. In my case, my mother had a will when she passed away in Vermont and I was her executor living in Virginia. I had to go through a time-consuming probate process to clear her property and other assets for distribution as she specified in the will. A will is an instruction sheet for probate; it’s not the ticket to get around probate.

That was in contrast to my wife’s experience with the recent passing of her mother in Oklahoma after a period of severe illness. Fortunately, her mom hired an attorney to establish a revocable trust, advance medical directives, and powers of attorney that enabled us to deal with her finances, health insurance, credit cards, banks, health care providers, hospice, and other agencies during her final months when she couldn’t care for herself. Since my wife was the successor trustee of the trust, and her mother’s bank accounts and other property were in the name of the trust, it was a simple matter to deal with her final expenses. The trust eliminated the probate process, and we distributed the assets to the other heirs based on the trust instructions. This experience validated my wife’s and my decision to set up a revocable family trust many years ago, for a number of reasons.

At the time, there was some uncertainty about the future of the estate tax and a trust was one way of preserving assets for our heirs. Since the law changed to exempt assets up to $11.2 million (inflation adjusted each year) per individual in 2018 from estate taxes, that is no longer an issue for the vast majority.

Because one of our children had gone through a divorce, we also saw a trust as a way to ensure our family assets would stay within the family (children and grandchildren) rather than to a former spouse, should one or more of the children’s families break up after our deaths.

Finally, our own experience with the probate process convinced us the revocable trust was the way to protect our own children from having to deal with that.

How much does it cost to set up a trust?

If you go to an attorney, most estimates are $1,000 to $3,000 or more, depending on what services are included. If you go with a legal firm specializing in estate planning, you might pay up to $5,000 or more for all-inclusive services. Another option is online companies that offer templates for trusts and other documents for several hundred dollars or less. This do-it-yourself method puts the work and risk on you to process everything correctly. Military retirees also might be able to get such forms and some assistance from military legal assistance offices, as my spouse and I initially did.

We failed to follow through (see below) on our original trust after realizing we needed a more personalized plan. We regrouped and went to a civilian firm. In addition to the basic trust document, the firm provided pour-over trusts for our children, advance medical directives, and powers of attorney and took care of the retitling of our house and establishing the new deed, among other things.

What are potential problems with setting up a trust?

If you’re like my wife and I, the biggest problem is putting the trust into effect — which means retitling your home under the trust and establishing the trust as the beneficiary of your life insurance and the owner of your brokerage accounts, mutual funds, and bank accounts, etcetera. Those things can be a hassle, and we never got around to doing it on our “first-try” trust. Whatever assets (e.g., vehicles) are not put in the name of the trust will be subject to probate upon your death. A few issues to consider when you establish a trust are:

Not keeping the trust document up-to-date over time. For example, if you establish more than one child as joint successor trustees and one passes away (as my wife’s brother did), you must amend the trust to reflect that death and establish a new successor trustee or trustees. The same is true if you want to make changes to your designated heirs due to a death or divorce.

How you safeguard your trust documents. For one thing, DO NOT put your trust documents in a safe deposit box (as my mother-in-law did). If that’s the only document you have to establish the successor trustee, your heirs will have great difficulty accessing it.

Make sure to provide your successor trustees a notarized copy of the trust document.

Are there assets you should not put under the trust umbrella?

If you have children of significantly different ages whom you’ve established as beneficiaries of your 401(k) or IRAs, you might want to consider leaving them that way rather than switching the beneficiary to the trust. Why? Because children who inherit 401(k)s and IRAs must immediately start taking minimum required distributions based on their age. If you make the trust the beneficiary for a 401(k) or IRA, then each child must start taking distributions based on the age of the oldest child. If they are left as individual beneficiaries on those accounts, each child’s required annual distribution is based on his or her own age.

In our case, our oldest child is 45 and our youngest is 33. The amount the older child must take as a taxable distribution from a regular inherited IRA or 401(k) is the same either way. However, the amount the younger child would have to take is about a third higher if the trust is the heir of the account — which means she could exhaust the assets too quickly.

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In the end, having a trust versus a will is a matter of cost, effort, and convenience. Having experienced the consequences of a parent’s death without a trust convinced us, in our case, it was worth some expense and administrative effort to ensure our desired distribution of assets and save (hopefully) our grieving heirs from excessive estate burdens when the time comes. [Source: MOAA Newsletter | Steve Strobridge | April 4, 2018 ++]

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Jury Duty Compensation ► May 7 Increase for Federal Courts

Folks who serve as jurors at federal courthouses will soon see a pay raise — their first in a couple of decades. nThe U.S. Courts, the federal court system, recently announced that the daily fee paid to jurors is rising 25 percent: from $40 to $50. This pay hike is the first for federal jurors since 1990. The new pay rate takes effect 7 MAY and will apply to folks who serve on federal grand juries and federal trial juries. The change does not apply to folks called for jury duty in state court systems — which tend to pay less, according to data compiled by the nonprofit National Center for State Courts.

The pay hike for federal jurors stems from the Consolidated Appropriations Act of 2018, the budget bill that became law in late March. It set spending levels for many divisions of the federal government for the 2018 fiscal year. The federal judiciary as a whole, which includes the U.S. Courts, received $7.1 billion in discretionary appropriations. According to a press release from the U.S. Courts, that’s an increase of 2.7 percent, or $184 million, from the prior year and is enough money to fund all judiciary accounts for the current fiscal year. U.S. District Chief Judge Ruben Castillo, a federal trial judge based in Illinois, tells the Chicago Tribune that the judiciary hopes the pay hike will ease the financial burden of serving as a juror, thereby making juries more reflective of the U.S. population. Castillo explained: “More diverse juries is what we’re all after.”

Under the Fair Labor Standards Act, employers are not required to pay employees for time they did not work, including while out for jury duty. So, jury pay is the extent of the income that some folks receive for days when they cannot work due to being called for jury duty or serving as a juror. [Source: MoneyTalksNews | Karla Bowsher | April 4, 2018 ++]

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Car Insurance Update 15 ► Low Mileage Discounts

If you’re hoping for a car insurance discount because you or someone else on your policy doesn’t drive much, you better shop around. Recent research by the nonprofit Consumer Federation of American (CFA) shows that while spending less time behind the wheel lessens your odds of getting into a crash, not all major auto insurers offer significant discounts to low-mileage drivers. On average, folks outside of California save $30 per year, or 1.6 percent, for every 5,000 fewer miles driven. That’s compared with an average savings of $81, or 8.7 percent, in California — which is an exception because its regulations require insurers to charge lower-mileage drivers less.

For its research, CFA got premium quotes for basic liability coverage in 12 different U.S. cities — one in California, and the rest elsewhere. The quotes were from five large auto insurers: Allstate, Farmers, Geico, Progressive, and State Farm The quotes all were for a driver with an unblemished record. So, the only differences between quotes, besides the insurers and the cities, was the number of miles driven per year. Annual mileage varied from 2,500 to 22,500. From one insurer to another, low-mileage discounts vary from nonexistent to double digits.

CFA singled out Farmers and Progressive as being particularly stingy in the 11 non-California cities included in CFA’s analysis: Progressive and Farmers usually charge the same rates to someone who drives only 2,500 miles a year as they charge someone else who drives 22,500 miles a year — nine times as far — all else being equal. Geico offers “a small price reduction” for lower-mileage drivers outside California, CFA found. Allstate and State Farm offer average reductions of 11 percent and 13 percent, respectively, outside California. CFA argues that car insurance rates should be based more on driving-related factors such as mileage than on socioeconomic factors like your credit score or marital status. J. Robert Hunter, director of CFA and a former Texas insurance commissioner, notes: “For people in most parts of the country, with California as the notable exception, you’ll often pay about the same auto insurance premium whether you commute 90 miles round trip every day or if you take public transit to work and only drive on the weekends.”

For its part, Progressive says on its website that it normally does not ask policyholders to report their mileage, but that it does reward low-mileage drivers through its Snapshot program, which monitors driving behavior in exchange for discounted rates. Farmers says on its website that drivers who limit their time behind the wheel “may therefore enjoy low-mileage discounts.” Nonetheless, until laws change outside of California, consider this a reminder of the

importance of periodically shopping your insurance policies around to confirm you’re getting the best rates for which you can qualify. [Source: MoneyTalksNews | Karla Bowsher | April 3, 2018 ++]

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Vet Benefit/Pension Buyout Scam ► How It works

Many Veterans depend on a pension to cover day-to-day as well as occasional unexpected expenses, such as health emergencies or home repairs. In a pension advance, a company pays the pension holder a lump sum (usually far less than the pension is worth) in exchange for a portion or all of the future pension payments. This can be an attractive arrangement to some retirees, especially those facing temporary hardships or financial challenges that need to be resolved quickly. But though pension advances may seem like a “quick fix” to financial problems, they can eat into or even deplete your retirement income when you start paying back the advance plus interest and fees.

More often than not, a pension advance is a raw deal. Pension advance companies deliberately target government retirees with pensions and typically charge high interest rates and fees for an advance. One representative from the Consumer Financial Protection Bureau said: “We’ve heard from Veterans paying interest rates as high as 106 percent.” Former service members should especially be on guard, because many of those shady companies use patriotic-sounding names or logos and even claim they are endorsed by the VA as a way of enticing potential customers.

If you or a loved one is considering a pension advance, consider your alternatives. According to the Consumer Financial Protection Bureau’s Office for Service Members, a financial coach or credit counselor can help you weigh your options. To get started, contact the Financial Counseling Association of America (800-450-1794) or the National Foundation for Credit Counseling (800-388-2227). Here are three things service members can do to protect their retirement pension:

Avoid loans with high fees and interest. Pension advance companies may not always advertise their fees and interest rates, but you will certainly feel them in your bottom line. Before you sign anything, learn what you are getting and how much you are giving up.

Don’t sign over control of your benefits. Companies sometimes arrange for monthly payments to be automatically deposited in a newly created bank account so the company can withdraw payments, fees, and interest charges from the account. This leaves you with little control.

Don’t buy life insurance that you don’t want or need. Pension advance companies sometimes require consumers to sign up for life insurance with the company as the consumer’s beneficiary. If you sign up for life insurance with the pension advance company as your beneficiary, you could end up footing the bill, whether you know it or not.

You can also get a printer-friendly version of this information to share with friends who are considering pension advances. Whether you’re thinking about giving to a Veterans charity or have been offered a cash advance of your pension, use extreme caution. Both of these decisions will likely be charged with emotion, but be smart and do some research before giving up anything. Scammers are determined to get their hands on your money or any personal information that might give them access to your money. If you or someone you know has encountered any military-affiliated scam, you can join the fight by sharing your experiences, good and bad, with our partners at the Fraud Watch Network (877-908-3360). [Source: VAntage Point | Marc Ewing | April 2, 2018 ++]

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Free Health Screening Scam ► How It works

"Free health screening!" This offer often pops up at local health fairs, senior housing, and community centers. Screenings are mostly an affordable way to stay on top of your health, and most providers are legitimate, but BBB has been hearing about scammers who use them as bait to steal sensitive personal information from unsuspecting victims.

How the Scam Works You show up for your free health screening, and the representative asks you to fill out a sign-in sheet. This

sheet asks for standard information, such as your name. But it also requests sensitive information, such as your Medicare or Social Security number. In some versions, "health company reps" claim that your health plan will cover the cost and send you the results. All you need to do is provide your ID and plan information.

Don't fall for it! Scammers may go through the motions of the health screening – such as taking your blood pressure or cholesterol levels -- only to use your personal information later. Scammers can use this information to bill your insurance for thousands of dollars' worth of tests, gain access to your personal genetic information, or simply to steal your identity.

Protect Yourself from Free Health Screening Scams Guard your personal information carefully. Never give your medical insurance ID number, Social Security

number, or banking information to strangers. It is illegal to accept anything of value in exchange for medical services. Never trade personal information

for "free" tests. Don't consent to lab tests without direct orders from your doctor. Protect yourself and your health insurance

benefits. Keep a close eye on correspondence from your medical insurance provider. Inform your provider right

away if you notice any unauthorized changes or charges.

Read more about healthcare scams at www.BBB.org/healthcarescam. In the United States, learn more about how to protect yourself from Medicare fraud at www.Medicare.gov. If you've fallen victim to this type of scam, you can help others avoid being scammed by filing a report with www.BBB.org/ScamTracker. Learn more about other scams and how to avoid them at www.BBB.org/scamtips. [Source: BBB Scam Alert | April 6, 2018 ++]

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Notes of Interest ► 01 thru 15 APR 2018

Battle Hymn of the Republic. Go to https://youtu.be/bf4TXjZrzAY to listen to Orson Welles tell the story of how the hymn came about.

Playboy. At http://myplaymates.club/1954 can be viewed every Playboy Playmate from 1954 thru 2016. If still living some would be 80 years old now.

Military Pilot Shortage. The military’s shortfall is reaching alarming proportions — and a new report from the Government Accountability Office shows just how bad the problem has become. The Air Force, Navy and Marine Corps are each short about a 25 percent of the fighter pilots they need in crucial areas, according to the GAO report released 11 APR, titled “DOD Needs to Reevaluate Fighter Pilot Workforce Requirements.”

China. China’s new defense minister Wei Fenghe has reportedly said during his visit to Moscow that China is ready to support Russia against the US. “I am visiting Russia as a new defense minister of China to show the world a high level of development of our bilateral relations and firm determination of our armed forces to strengthen strategic cooperation.”

Involuntary Extension. Air Force Reserve pilots, maintainers, space operators and cyber specialists who want to quit the service will have to stay in uniform for at least six months under a plan to address critical skills shortages. The involuntary service commitment is to ensure that the Air Force Reserve meets recruiting and end-strength goals, according to a memo on the policy that went into effect 1 APR.

Vet Unemployment. As the national unemployment rate remained unchanged for the sixth month in a row, the percentage of veterans without jobs ticked upward in March, the latest federal figures show. The unemployment rate among post-9/11 veterans grew to 5 percent last month — up from 3.3 percent in February, according to the Bureau of Labor Statistics. For veterans of all eras, the unemployment rate rose from 3.5 to 4.1 percent, slightly higher than the nonveteran rate of 4 percent.

What Policemen Must Deal With. Very graphic. To see what happens when a suspect pulls a gun go to https://video.twimg.com/ext_tw_video/949109023688634368/pu/vid/1280x720/04WCi3g3_pmAtBgk.mp4.

Eating Out. A French restaurant came up with an original way to entertain guests while waiting for their order by using an overhead projector on the ceiling. The animation is on the table and your plate. There is a small chef who appears on your plate, ...watch what he does at https://www.youtube.com/embed/yBJEP4lsRFY. Bon Appetite’!!

Child Credit Report. It’s a good idea to check whether your child has a credit report close to the child’s 16th birthday. If there is one — and it has errors due to fraud or misuse — you will have time to correct it before the child applies for a job, a loan for tuition or a car, or needs to rent an apartment.

Deficit. The federal government’s annual budget deficit is set to widen significantly in the next few years, and is expected to top $1 trillion in 2020 despite healthy economic growth, according to new projections from the nonpartisan Congressional Budget Office released 9 APR. The national debt, which has exceeded $21 trillion, will soar to more than $33 trillion in 2028, according to the budget office

Government Pay. The Federal Salary Council reported on 10 APR that federal employees on average earn 31.86 percent less than their counterparts in non-federal jobs, said an advisory council on compensation issues. The Congressional Budget Office, which uses a different methodology found last year that feds made 17 percent more than those in the private sector from 2011 through 2015.

Female Submariners. The Navy has extended the April deadline for female enlisted sailors to apply to convert to submarine force ratings. Sailors ranks E-1 through E-8 now have until June 1 to submit their applications, according to a Navy release. The traditionally all-male submarine force was first opened to female officers in 2011. The Navy has plans to add 550 enlisted women to seven Ohio-class subs by 2020.

Federal Taxes. “What percentage of your household’s income would you say is paid in federal income tax?” The vast majority of Americans believe they pay a lot more in than they actually do, based on recent research. About 85 percent of folks overstated their average income tax rate — by 11.6%. Average paid is 13.9%.

Pillows. The cleaning experts suggest washing pillows at least twice a year. The best way to check whether you should throw away a pillow is to fold it in half and see if springs back into shape. If it doesn’t, it’s time to buy a new one.

Birth Year. Did you know that seventy-seven years minus your age plus 40 equals the last two digits of the year you were born in.

Battle-of-Athens. Go to https://youtu.be/U5ut6yPrObw to view a 13 minute clip on an actual event 1-2 AUG 1946 in which American veterans took up arms to restore law and order in their town from a corrupt political regime.

[Source: Various | April 15, 2018 ++]

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California Statehood ► Three State Proposal

There’s an effort to split California into three new states that’s gaining steam — and it may be heading to the ballot box in the 2018 midterm election. It’s a question that could forever reshape America, and it’s already well on it’s way to the voting booth. Tech billionaire and bitcoin enthusiast Timothy Draper wants to carve California into three separate states. This week, his initiative cleared the first legal hurdle needed to divide up the Golden State permanently. California Secretary of State Alex Padilla announced 12 APR that Draper is allowed to take the next step and circulate a petition among California residents. If he’s able to obtain 365,880 signatures from registered voters within the next 180 days, the state of California will officially vote to split apart after the 2018 election.

The new states would be divided by geographic area, according to the proposed measure. Northern California would encompass everything from Oregon to San Francisco county. Southern California would begin south of San Francisco in Fresno and cover nearly everything to Mexico. New California would be Los Angeles and much of the central and southern coast. Should the measure gains enough signatures and voters choose to divide up the Golden State, California state’s assets and debts would be divided evenly among the three new entities. According to a local Bay Area NBC News affiliate in California, the state would be divided accordingly:

CALIFORNIA: Los Angeles, Monterey, San Benito, San Luis Obispo, Santa Barbara, Ventura SOUTHERN CALIFORNIA: Fresno, Imperial, Inyo, Kern, Kings, Madera, Mono, Orange, Riverside, San

Bernardino, San Diego, Tulare NORTHERN CALIFORNIA: Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del

Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa, Mendocino, Merced, Modoc, Napa, Nevada, Placer, Plumas, Sacramento, San Francisco, San Joaqui, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, Yolo, Yuba.

The idea of the vote making it to the ballot isn’t too farfetched, either. After all, Californians once voted to allow a police officer in San Francisco walk his beat with his ventriloquist dummy. They tried to ban hippies from sitting on sidewalks (but failed). California even voted once to ban the sale of horse meat to Europe on a statewide ballot. Is it so much of a stretch to think that a billionaire could find over 365,000 people who want to divide the state into three? If the initiative passes, it would mean the new state(s) map would look like the following:

[Source: The Horn News | April 12, 2018 ++]

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Children’s Online Safety ► BBB Tips

From “tweens” getting their first smart phone, to preschoolers playing games on mom’s tablet, to students researching a science fair project, more and more kids are getting online every day. Nearly half of children in 1st-4th grade have regular access to a cell phone, and the majority of middle and high school students have their own phones. Parents are concerned about what their children may be seeing online, but they should also be concerned about what they are sharing online. Better Business Bureau and its national Children’s Advertising Review Unit (CARU) have these tips for parents:

Talk to your kids. If you’re not already talking to your children about what they read and watch – or where they play and how they interact online – now is the time to start. Check out BBB Children’s Online Safety (www.bbb.org/kidsonline) and CARU’s “A Parent’s Guide to Children and Advertising.”

Spend some time with your children online. What sites do they visit? What activities do they take part in? Are these sites appropriate for your child’s level of development? Do bloggers disclose if they get paid for talking about products?

Explain about online advertising. Just like the overall online experience, online advertising is interactive. Help your children understand that banner ads, pop ups and the like are designed to get you to click. To avoid phishing and scammers, make a family rule about when they are allowed to click and when not.

Have a rule about sharing. Tell your children to ask you before they share personal information or photos online. Once that information is on the web, you may not be able to control who sees it and how they use it. Your children should always tell you the types of information they are asked to share or want to share online.

Use parental controls. Computers, Internet browsers, tablets and mobile phones have parental controls that you can use to place limits on where your children go online, the types of advertising they may encounter, even the hours they can access the device. Get to know what controls are available to you as a parent and learn how to use them. Start with your mobile carrier; most have extensive online resources for parents.

Understand apps. Short for “applications,” apps are downloaded software that can run on various devices. However, there are some things you should know. Apps might collect and share personal information about your child. They may include ads that aren’t labeled as such. Even free apps may include paid features, and children may not understand that some apps or game features cost money, since they were labeled as free to download.

Read privacy policies. Apps, games, social media sites and other services all should have a privacy policy and terms of use statement readily available. In many cases, you can restrict an app’s access to additional information on your phone or other device. For instance, you may want to allow a social media site access to photos stored on

your phone so that you can easily post them to share with your friends, but you may want to restrict the site’s access to other data on your phone.

[Source: Better Business Bureau | October 9, 2017 ++]

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Gun Control Update 03 ► Right To Bear Arms

In 1929, the Soviet Union established gun control. From 1929 to 1953, about 20 million dissidents, unable to defend themselves, were rounded up and exterminated.

In 1911, Turkey established gun control. From 1915 to 1917, 1.5 million Armenians, unable to defend themselves, were rounded up and exterminated.

Germany established gun control in 1938 and from 1939 to 1945, a total of 13 million Jews and others who were unable to defend themselves were rounded up and exterminated.

China established gun control in 1935. From 1948 to 1952, 20 million political dissidents, unable to defend themselves were rounded up and exterminated.

Guatemala established gun control in 1964. From 1964 to 1981, 100,000 Mayan Indians, unable to defend themselves, were rounded up and exterminated.

Uganda established gun control in 1970. From 1971 to 1979, 300,000 Christians, unable to defend themselves, were rounded up and exterminated.

Cambodia established gun control in 1956. From 1975 to 1977, one million educated people, unable to defend themselves, were rounded up and exterminated.

Mass killings of civilians by military dictatorships in the 1900s were more often than not preceded by the confiscation of firearms from targeted populations, a task made easier by laws requiring the registration and/or licensing of privately-owned weapons. However, "Gun control" isn't synonymous with gun confiscation, in some genocide cases gun restriction laws had already been in place for many years prior, and evidence does not demonstrate a causal link between gun control and mass exterminations.

During WWII the Japanese decided not to invade America. One alleged factor in their decision was they knew most Americans were armed. Switzerland issues every household a gun. Switzerland's government trains every adult to whom they issue a rifle. Switzerland has the lowest gun related crime rate of any civilized country in the world. While it has a low overall crime rate by European standards, it has one of the highest gun suicide rates in Europe. However, it also has one of the world's lowest overall homicide rates, considerably lower than the European average. Their gun homicide rate ranks in the middle of Western European countries.

The right to keep and bear arms is the people's right to possess weapons (arms) for their own defense, as described in the philosophical and political writings of Aristotle, Cicero, John Locke, Machiavelli, the English Whigs and others. Inclusion of this right in a written constitution is uncommon. In 1875, only 17 percent of constitutions included a right to bear arms, yet, since the early twentieth century, "the proportion has been less than 9 percent and falling". In their historical survey and comparative analysis of constitutions dating back to 1789, Tom Ginsburg

and colleagues "identified only 15 constitutions (in nine countries) that had ever included an explicit right to bear arms. Almost all of these constitutions have been in Latin America, and most were from the 19th century".

Generally, where modern constitutions refer to arms at all, the purpose is "to allow the government to regulate their use or to compel military service, not to provide a right to bear them". Constitutions which historically guaranteed a right to bear arms are those of Bolivia, Colombia, Costa Rica, Guatemala, Honduras, Liberia, Mexico, Nicaragua and the United States of America. Nearly all of the Latin American examples were modeled on that of the United States. At present, out of the world’s nearly 200 constitutions, three still include a right to bear arms: Guatemala, Mexico, and the United States (2nd Amendment); of these three, only the U.S. does not include explicit restrictive conditions. [Source: www.snopes.com & https://en.wikipedia.org/wiki/Right_to_keep_and_bear_arms | April 9, 2018 ++]

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Vinegar Update 03 ► Multiple Uses | Household Hints, Yard & Garden, and Car Care

Household Hints

1. Coffee scrub -- If your favorite coffee or tea mug has dark stains, scour with a 1-to-1 mix of vinegar and salt. Rinse well in warm water.

2. Stop mold -- Spray undiluted vinegar onto areas that develop mold or mildew. You can add a bit of essential oil to the spray bottle, but remember, the vinegar smell will go away.

3. Clean filters -- Soak humidifier or air conditioner filters in a 50/50 solution of vinegar and water, then rinse and squeeze dry.

4. Sanitize cutting boards -- After washing cutting boards, spray with undiluted white vinegar to further disinfect the surface. Bonus: It’ll neutralize the odor of that fish you just cut up.

5. Go grill crazy -- Are charcoal and food juice gumming up your grill? Spray thoroughly with undiluted vinegar, wait a couple of minutes and scrub with a wire brush or some crumpled-up aluminum foil.

6. Clean the iron -- Spray starch can build up on the faceplate of your iron, so wipe it with vinegar every so often. If you’ve got hard water, clean the iron’s innards every now and then: Fill the water reservoir with vinegar, stand it upright and turn on the “steam” setting. After 10 minutes, empty and rinse well.

7. Cleanse copper -- If your copper-bottomed cookware is discolored, apply a paste of equal parts salt, flour and vinegar. Let stand for no more than 30 minutes, then rinse well.

Yard & Garden

1. Bug killer -- Cider vinegar stinks to us, but it attracts insects. Create a funnel trap by rolling a sheet of notebook paper into a funnel and placing it into a jar with cider vinegar at the bottom. This works in the kitchen for fruit flies and on the deck when entertaining outdoors.

2. Ant killer -- That vinegar-and-dish-soap cleaner also vanquishes uninvited guests that march into your home. This mixture is a lot less worrisome than spraying a pesticide ant killer around the area where your kids and pets play, and around the areas where you prepare food. Some folks swear by vinegar sprayed or poured on anthills.

3. Feeder cleaner -- A good wash with a gentle dish soap, followed by a spray with a 50/50 vinegar solution, means clean dishes (and less chance of bacterial issues) for hummingbirds and other feathered friends.

4. Flowerpot freshener -- White stains on terra-cotta pots won’t come off with soap and water? Wipe down with undiluted vinegar and let dry. After that, rub with baby oil.

5. Mower helper -- Once you’ve finished the lawn, wipe the blades down with vinegar — not just to clean off grass bits, but also any insects that might have hitched a ride while you rolled the mower back to the garage.

6. Critter repellent -- Some say that deer, raccoons, rabbits, dogs and cats don’t like the smell of vinegar. Try hanging up vinegar-soaked rags near your garden (re-wetting them once a week) and spraying your garbage cans with the stuff. It may not work in every case, but it’s worth a try.

7. Make paint stick -- If you’re painting concrete or galvanized metal, pretreat the area by sponging on vinegar and allowing it to dry. The paint will last longer.

8. Clean paintbrushes -- Is your synthetic-bristle brush completely paint-stiffened? Soak in undiluted vinegar until things are moving again, then wash with soap and hot water.

9. Soil tester -- Pour a half-cup of white vinegar over a handful of garden soil in a container. Fizzy/bubbly means alkaline. Science!

Caring for Your Car

1. Wiper magic -- Rub windshield wiper blades a couple of times with undiluted vinegar.

2. Clearer windows -- Wipe windows and the windshield with a 3-to-1 mixture of vinegar and water. This makes it harder for frost to form. Reapply when it stops working.

3. Revive the rug -- After vacuuming your vehicle, sponge carpeting with a 50/50 vinegar-water mixture. Blot after a couple of minutes.

[Source: MoneyTalksNews | Donna Freedman | March 7, 2018 ++]

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Have You Heard? ► Trivia | Origin of Phrases/Words

Drinking: There is an old Hotel/Pub in Marble Arch, London, which used to have a gallows adjacent to it. Prisoners were taken to the gallows (after a fair trial of course) to be hanged. The horse-drawn dray, carting the prisoner, was accompanied by an armed guard, who would stop the dray outside the pub and ask the prisoner if he would like ''ONE LAST DRINK''. If he said YES, it was referred to as ONE FOR THE ROAD. If he declined, that prisoner was ON THE WAGON.

Poverty: They used to use urine to tan animal skins, so families used to all pee in a pot and then once a day it was taken and sold to the tannery. If you had to do this to survive you were " piss poor", but worse than that were the really poor folk, who couldn't even afford to buy a pot, they "Didn't have a pot to piss in" and were the lowest of the low.

Cleanliness: The next time you are washing your hands and complain because the water temperature isn't just how you like it, think about how things used to be. Here are some facts about the 1500s:

Most people got married in June, because they took their yearly bath in May and they still smelled pretty good by June. However, since they were starting to smell, brides carried a bouquet of flowers to hide the body odor. Hence the custom today of carrying a bouquet when getting married.

Baths consisted of a big tub filled with hot water. The man of the house had the privilege of the nice clean water, then all the other sons and men, then the women and finally the children. Last of all the babies. By then the water was so dirty you could actually lose someone in it. Hence the saying, "Don't throw the baby out with the bath water!"

Houses had thatched roofs, thick straw piled high, with no wood underneath. It was the only place for animals to get warm, so all the cats and other small animals (mice, bugs) lived in the roof. When it rained it became slippery and sometimes the animals would slip and fall off the roof. Hence the saying " It's raining cats and dogs."

There was nothing to stop things from falling into the house. This posed a real problem in the bedroom, where bugs and other droppings could mess up your nice clean bed. Hence, a bed with big posts and a sheet hung over the top afforded some protection. That's how canopy beds came into existence.

The floor was dirt. Only the wealthy had something other than dirt. Hence the saying, "dirt poor." The wealthy had slate floors that would get slippery in the winter when wet, so they spread thresh (straw)

on floor to help keep their footing. As the winter wore on they added more thresh until, when you opened the door, it would all start slipping outside. A piece of wood was placed in the entrance-way. Hence: a thresh hold.

Food:

In those old days, they cooked in the kitchen with a big kettle that always hung over the fire. Every day they lit the fire and added things to the pot. They ate mostly vegetables and did not get much meat. They would eat the stew for dinner, leaving leftovers in the pot to get cold overnight, then start over the next day. Sometimes stew had food in it that had been there for quite a while. Hence the rhyme: '' Peas porridge hot, peas porridge cold, peas porridge in the pot, nine days old''.

Sometimes they could obtain pork, which made them feel quite special. When visitors came over they would hang up their bacon, to show off. It was a sign of wealth that a man could, "Bring home the bacon." They would cut off a little to share with guests and would all sit around talking and ''chew the fat.''

Those with money had plates made of pewter. Food with high acid content caused some of the lead to leach onto the food, causing lead poisoning and death. This happened most often with tomatoes, so for the next 400 years or so, tomatoes were considered poisonous.

Bread was divided according to status. Workers got the burnt bottom of the loaf, the family got the middle, and guests got the top, or ''The Upper Crust''.

Lead cups were used to drink ale or whisky. The combination would sometimes knock the imbibers out for a couple of days. Someone walking along the road would take them for dead and prepare them for burial. They were laid out on the kitchen table for a couple of days and the family would gather around and eat and drink and wait and see if they would wake up. Hence the; custom of ''Holding a Wake''.

Death: England is old and small and the local folks started running out of places to bury people, so they would dig up coffins and would take the bones to a bone-house and reuse the grave. When reopening these coffins, 1 out of 25 coffins were found to have scratch marks on the inside and they realized they had been burying people alive. So they would tie a string on the wrist of the corpse, thread it through the coffin and up through the ground and tie it to a bell. Someone would have to sit out in the graveyard all night (the graveyard shift) to listen for the bell; thus someone could be, ''Saved by the Bell '' or was considered a ''Dead Ringer'' And that's the truth.

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